背景:自发性气胸(PTX)在COVID-19患者中比其他危重患者更普遍,但这方面的研究是有限的。本研究比较了合并PTX的COVID-19患者的临床特征和住院结局,以深入了解PTX如何影响医疗保健利用和并发症,为临床决策和医疗保健资源分配提供信息。
方法:使用2020年全国住院患者样本分析患者的人口统计学和结果,包括年龄,种族,性别,保险状况,中位数收入,住院时间,死亡率,住院费用,合并症,机械通气,和血管加压药支持。采用倾向得分匹配进行额外分析。
结果:在1,572,815例COVID-19患者中,1.41%有PTX。这些患者的住院费用显着增加(435,508美元与$96,668,p<0.001)和更长时间的住宿(23.6天vs.8.6天,p<0.001)。PTX患者的住院死亡率显着升高(65.8%vs.14.4%,p<0.001),调整后的比值比为14.3(95%CI12.7-16.2)。此外,这些患者更可能需要血管加压药(16.6%vs.3.3%),机械循环支持(3.5%vs.0.3%),血液透析(16.6%vs.5.6%),有创机械通气(76.9%vs.15.1%),无创机械通气(19.1%vs.5.8%),气管造口术(13.3%vs.1.1%),和胸管放置(59.8%vs.0.8%)。
结论:我们的发现强调了PTX对COVID-19患者的严重影响,以死亡率较高为特征,更多的并发症,提高资源利用率。此外,作为西班牙裔,男性,或肥胖会增加与COVID-19并发PTX的风险。
BACKGROUND: Spontaneous pneumothorax (PTX) is more prevalent among COVID-19 patients than other critically ill patients, but studies on this are limited. This study compared clinical characteristics and in-hospital outcomes among COVID-19 patients with concomitant PTX to provide insight into how PTX affects health care utilization and complications, which informs clinical decisions and healthcare resource allocation.
METHODS: The 2020 Nationwide Inpatient Sample was used analyze patient demographics and outcomes, including age, race, sex, insurance status, median income, length of hospital stay, mortality rate, hospitalization costs, comorbidities, mechanical ventilation, and vasopressor support. Propensity score matching was employed for additional analysis.
RESULTS: Among 1,572,815 COVID-19 patients, 1.41% had PTX. These patients incurred significantly higher hospitalization costs ($435,508 vs. $96,668, p < 0.001) and longer stays (23.6 days vs. 8.6 days, p < 0.001). In-hospital mortality was substantially elevated for PTX patients (65.8% vs. 14.4%, p < 0.001), with an adjusted odds ratio of 14.3 (95% CI 12.7-16.2). Additionally, these patients were more likely to require vasopressors (16.6% vs. 3.3%), mechanical circulatory support (3.5% vs. 0.3%), hemodialysis (16.6% vs. 5.6%), invasive mechanical ventilation (76.9% vs. 15.1%), non-invasive mechanical ventilation (19.1% vs. 5.8%), tracheostomy (13.3% vs. 1.1%), and chest tube placement (59.8% vs. 0.8%).
CONCLUSIONS: Our findings highlight the severe impact of PTX on COVID-19 patients, characterized by higher mortality, more complications, and increased resource utilization. Also, being Hispanic, male, or obese increased the risk of developing concomitant PTX with COVID-19.