The Effect of Covid-19 on Spontaneous Pneumothorax

ABSTRACT

RATIONALE SARS-COV-2 (COVID-19) has presented challenges to hospitals from its initial onset in 2020. Physicians at Lakeland Regional Medical Center (LRH) suspected an increase of spontaneous pneumothorax (PTX) in patients admitted with COVID-19 through the emergency department (LRH has 220,000 ED-visits per year). The suspicion was supported by a small body of literature reporting COVID-19's association with PTX (mainly in the form of small case series or reports). The purpose of this study was to examine the effect that COVID-19 has on PTX incidence on a much larger scale. METHODS: We conducted a retrospective chart review extracting data on admitted patients between March 2020 and December 2021. Data included age, sex, COVID-19 positivity status, intubation (at any time during hospitalization), and PTX occurrence. We compared PTX rates between COVID-19 positive/negative patients and between patients who were intubated or not. A series of chi-square tests (alpha at < .05) were used for comparisons, as well as to calculate odds ratios (OR). Lastly, a binomial logistic regression was conducted to examine the effect of COVID-19 positivity, intubation status, and the interaction of COVID-19 positivity and intubation status, while controlling for age and sex, on odds for developing PTX. RESULTS: There were 50,456 patients included in our analyses. PTX incidence was 2.3% for COVID-19 positive versus 0.62% for COVID-19 negative. There was a significant association (p<0.0001) and 366% increased odds of developing PTX if patients were COVID-19 positive (95% CI [2.99, 4.46]). Intubation in itself had a significant association (p < 0.0001) and OR of 10.35 (95% CI [8.90, 12.04]) for developing PTX, but results of logistic regression revealed a strong interaction between COVIDpositivity and intubation status. Using COVID-19 negative and intubated patients as our reference group, we found that COVID-19 positive and intubated patients were at 6.56 increased odds of developing a PTX. COVID-19 positivity did not appear to have a significant association with PTX in the non-intubated patients. CONCLUSIONS: PTX is a rare, serious potential complication of COVID-19. This complication has considerable morbidity, especially in patients requiring intubation and should require strong clinical suspicion in COVID-19 positive patients. Research is needed to identify other key factors (i.e. underlying pulmonary disease, oxygen requirements, illness severity) that influence outcomes of patients with COVID-19.