背景:在2019年冠状病毒病(COVID-19)肺炎住院患者中观察到纵隔肺炎的发病率增加。该研究旨在确定COVID-19相关纵隔气肿的危险因素,并探讨纵隔气肿对临床结局的影响。
方法:在这项多中心回顾性病例对照研究中,我们纳入了2020年3月至2020年7月在10个中心住院的连续COVID-19肺炎和纵隔肺炎患者;然后,我们确定了一个规模相似的对照组,其中连续住院的COVID-19肺炎和呼吸衰竭患者在同一时期没有发生纵隔肺炎.临床,实验室,和放射学特征,以及呼吸支持和结果,收集并比较两组。采用多因素logistic分析评估纵隔气肿的危险因素。
结果:共分析了139例纵隔气肿患者和153例非纵隔气肿患者。肺受累≥75%,合并,体重指数(BMI)<22kg/m2,C反应蛋白(CRP)>150mg/L,D-二聚体>3000ng/mLFEU,吸烟暴露>20包年均与纵隔气肿的发生独立相关。纵隔气肿患者的住院时间更长(平均±SD31.2±20.2天vs19.6±14.2,p<0.001),插管率较高(73/139,52.5%vs27/153,17.6%,p<0.001),和住院死亡率(68/139,48.9%vs36/153,23.5%,p<0.001)与对照组相比。
结论:广泛的肺实质受累,合并,低BMI,高炎症标志物,和烟草暴露与COVID-19肺炎中纵隔肺炎的风险更大。这种并发症显著恶化了结果。
BACKGROUND: An increased incidence of pneumomediastinum has been observed among patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. The study aimed to identify risk factors for COVID-19-associated pneumomediastinum and investigate the impact of pneumomediastinum on clinical outcomes.
METHODS: In this multicentre retrospective case-control study, we included consecutive patients with COVID-19 pneumonia and pneumomediastinum hospitalized from March 2020 to July 2020 at ten centres; then, we identified a similarly sized control group of consecutive patients hospitalized with COVID-19 pneumonia and respiratory failure who did not develop pneumomediastinum during the same period. Clinical, laboratory, and radiological characteristics, as well as respiratory support and outcomes, were collected and compared between the two groups. Risk factors of pneumomediastinum were assessed by multivariable logistic analysis.
RESULTS: Overall 139 patients with pneumomediastinum and 153 without pneumomediastinum were analysed. Lung involvement ≥75 %, consolidations, body mass index (BMI) < 22 kg/m2, C-reactive protein (CRP) > 150 mg/L, D-dimer >3000 ng/mL FEUs, and smoking exposure >20 pack-year were all independently correlated with the occurrence of pneumomediastinum. Patients with pneumomediastinum had a longer hospital stay (mean ± SD 31.2 ± 20.2 days vs 19.6 ± 14.2, p < 0.001), higher intubation rate (73/139, 52.5 % vs 27/153, 17.6 %, p < 0.001), and in-hospital mortality (68/139, 48.9 % vs 36/153, 23.5 %, p < 0.001) compared to controls.
CONCLUSIONS: Extensive lung parenchyma involvement, consolidations, low BMI, high inflammatory markers, and tobacco exposure are associated with a greater risk of pneumomediastinum in COVID-19 pneumonia. This complication significantly worsens the outcomes.