mSOFA Scores Associated with the Development of Pneumothorax, Pneumomediastinum and Subcutaneous Emphysema in Critically Ill Covid-19 Patient

ABSTRACT

Introduction: COVID-19 is a well-known cause of severe ARDS (acute respiratory distress syndrome), however recent data suggests that COVID-19 could represent a unique form of lung injury that places patients at increased risk of various uncommon complications such as pneumothorax, pneumomediastinum and subcutaneous emphysema. Studies so far have reported an increased incidence of barotrauma in intubated COVID-19 patients with unclear predictors. Our study aims to identify the different variables associated with development of pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill COVID-19 patients. Methods: We examined patients admitted to the intensive care unit from March 2020 to Feb 2021 at a large tertiary care center in Detroit, Michigan. We identified a total of 25 patients with COVID-19 ARDS requiring mechanical ventilation who developed pneumothorax, 12 who developed pneumomediastinum and 7 with subcutaneous emphysema. We compared those to 66 patients admitted with COVID-19 ARDS also requiring mechanical ventilation who did not develop any of these complications. The mean age of patients in our subject group was 61.81 years compared to a mean of 69.05 years in the control group. Male patients accounted for 58.33% of the subject group and 60.61% in the control group. Results: we detected a statistically significant difference in the modified Sequential Organ Failure Assessment Score (mSOFA) between the patients who developed these complications compared to those who did not (p<0.0001), with score being surprisingly lower in the group who developed the complication as opposed to those who did not (median mSOFA in subjects 3.5, n=32 vs median mSOFA in controls 11, n=66). Analysis of the subgroups of the mSOFA score revealed no statistically significant difference in the PF ratio (p=0.1995), platelet counts (p=0.065) and total bilirubin (p=0.4403). However, MAP was noted to be significantly lower in the control group than in the subject group accounting for a higher mSOFA score (p=0.0031). Similarly, creatinine was noted to be higher in the control group (p<0.0001) compared to the subject group. Discussion: In viewing our baseline patient characteristics we found a statistically significant difference (p<0.0001) in the rate of baseline chronic kidney disease between our subjects and control patients, with control patients having 100% baseline CKD and subjects having 19.4% baseline CKD. This could account for the higher mSOFA scores in controls. Conclusion: mSOFA did not predict the development of pneumothorax, pneumomediastinum or subcutaneous emphysema in patients admitted with COVID-19 ARDS requiring mechanical ventilation.