Risk Factors of Pulmonary Complications in Patients with COVID-19: A Case-Control Study

Background: Pneumothorax (PTX), pneumomediastinum (PM), and subcutaneous emphysema (SE) are complications associated with COVID-19. It is crucial to study these risk factors, complications, and their prognosis for early diagnosis amidst the rising number of cases today. Methods: We conducted a case-control study involving 81 pairs of patients diagnosed with SARS-CoV-2 pneumonia complicated by Pneumothorax and pneumomediastinum, comparing them with patients who did not have these complications to assess the risk factors for and prognosis of pulmonary complications in COVID-19. Results: The demographic data and medical history of comorbid diseases did not show an association with PTX, PM, and SE in COVID-19 pneumonia (all P-values > 0.05). However, laboratory data such as white blood cell count, lymphocyte count, C-reactive protein, lactate dehydrogenase, troponin, and D-dimer levels were significantly higher in the group with complications (P < 0.05). Additionally, the length of hospital stay was significantly longer in the group with complications, and intubation further extended this duration. The mortality rate was significantly higher in the case group (70% vs. 14%, P < 0.0001), with a significant odds ratio in comparison to patients without complications in the regression model (B = 2.61, Exp(B) = 13.65 with a 95% CI of 6.28 - 29.69). Conclusions: Pulmonary complications worsen the prognosis of COVID-19. The pathophysiology of COVID-19 pneumonia can lead to mechanical barotrauma, regardless of intubation status. Ventilator settings should be adjusted below the confidence level. Acute phase reactants and certain inflammatory markers, except for the erythrocyte sedimentation rate (ESR), are elevated in patients with complications, though they do not significantly predict outcomes.