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The Relationship Between Pneumothorax and Lymphopenia In Patients with Covid-19 Pneumonia

Yıl 2024, Cilt: 34 Sayı: 5, 616 - 623, 31.10.2024
https://doi.org/10.54005/geneltip.1411168

Öz

Background: Pneumothorax and lymphopenia regarded as poor prognostic factors in covid-19 pneumonia.In this study, we aimed to determine whether there is a relationship between pneumothorax and lymphopenia in patients admitted to the intensive care unit due to COVID-19 pneumonia and evaluate whether lymphocyte count can be used to predict the development of pneumothorax.
Methods: We reviewed the records of 50 patients with COVID-19 pneumonia retrospectively who developed pneumothorax and underwent tube thoracostomy at our hospital's intesive care units
Results : There were 32 women and 18 men with a mean age of 67.98 years.Of the patients who developed pneumothorax, 78% were intubated. 86% of the patients with pneumothorax died.The risk of mortality in patients with pneumothorax decreased 0.198 times as lymphocyte count increased. In ROC curve analysis based on intubation status, a cut-off value of 1.02 for lymphocyte count is statistically significant.
Conclusions: In this study, we observed that intubated patients had a high likelihood of developing pneumothorax and that concomitant deep lymphopenia was directly associated with mortality. The results highlight that during intensive care follow-up, it must be kept in mind that poor prognostic factors can interact to result in more serious prognostic implications

Kaynakça

  • World Health Organization. (‎2020)‎. Clinical management of COVID-19: interim guidance, World Health Organization, 2020.
  • Elder C, Bawa S, Anderson D, Atkinson S, Etzel J. Moritz T. Expectant management of pneumothorax in intubated COVID-19 positive patients: a case series. J Cardiothorac Surg 2020;15(1):263.
  • Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND, et. al. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J 2020;56(5):2002697.
  • Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res 2020;21(1):236.
  • Talan L, Şaşal Solmaz FG, Ercan U, Akdemir Kalkan İ, Yenigün BM, Yüksel C, et. al. COVID-19 pneumonia and pneumothorax: case series. Tuberk Toraks 2020;68(4):437-43.
  • Xu Y, Li S, Liu H. Clinical outcomes of pleural drainage on pneumothorax and hydrothorax in critically ill patients with COVID-19: A case series with literature review. Heart Lung 2021;50(2):213-19.
  • Ulutas H, Celik MR, Gulcek I, et al. Management of spontaneous pneumothorax in patients with COVID-19. Interact Cardiovasc Thorac Surg. 2022; 34 (6): 1002-1010. doi:10.1093/icvts/ivab280
  • Al-Ani A, AbuZayda H, Ahmed H, et al. Limitation of tube thoracostomy in treating pneumothorax in COVID-19 infected patients. A retrospective cohort study. Ann Med Surg (Lond). 2022;80:104171. doi:10.1016/j.amsu.2022.104171
  • Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020;58(7):1021-28.
  • Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci 2020;57(6):389-399.
  • Ciaccio M, Agnello L. Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis (Berl) 2020;7(4):365-72.
  • Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13
  • Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Analysis of 92 deceased patients with Covid-19. J Med Virol 2020; 92: 2511–15.
  • Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020;215:87–93.
  • Pieracci FM, Burlew CC, Spain D, Livingston DH, Bulger EM, Davis KA et al. Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees. Trauma Surg Acute Care Open 2020;5:e000498.
  • Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8(4):e26. doi: 10.1016/S2213-2600(20)30103-X]. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5
  • Gomersall CD, Joynt GM, Lam P, et al. Short-term outcome of critically ill patients with severe acute respiratory syndrome. Intensive Care Med. 2004;30(3):381-387. doi:10.1007/s00134-003-2143-y
  • Yarmus L, Feller-Kopman D. Pneumothorax in the critically ill patient. Chest. 2012;141(4):1098-1105. doi:10.1378/chest.11-1691
  • Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020. doi:10.1093/cid/ciaa248.
  • Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19. J Infect 2020;80:607–13.

Covid-19 Pnömonisi Olan Hastalarda Pnömotoraks ve Lenfopeni Arasındaki İlişki

Yıl 2024, Cilt: 34 Sayı: 5, 616 - 623, 31.10.2024
https://doi.org/10.54005/geneltip.1411168

Öz

Giriş: Pnömotoraks ve lenfopeni, covid-19 pnömonisinde kötü prognostik faktörler olarak kabul edilmektedir. Bu çalışmada, COVID-19 pnömonisi nedeniyle yoğun bakım ünitesine başvuran hastalarda pnömotoraks ve lenfopeni arasında bir ilişki olup olmadığını belirlemeyi ve lenfosit sayımının pnömotoraks gelişimini tahmin etmede kullanılıp kullanılamayacağını değerlendirmeyi amaçladık.
Method: Hastanemiz yoğun bakım ünitelerinde pnömotoraks gelişen ve tüp torakostomi uygulanan COVID-19 pnömonisi gelişen 50 hastasının kayıtlarını retrospektif olarak inceledik.
Bulgular: Yaş ortalaması 67.98 olan 32 kadın ve 18 erkek vardı. Pnömotoraks gelişen hastaların %78' i entübe edildi. Pnömotorakslı hastaların %86' sı öldü. Lenfosit sayısı arttıkça pnömotorakslı hastalarda ölüm riski 0,198 kat azaldı. Entübasyon durumuna dayalı ROC eğrisi analizinde, lenfosit sayısı için 1,02' lik bir cut-off değeri istatistiksel olarak anlamlı geldi.
Sonuçlar: Bu çalışmada entübe hastalarda pnömotoraks gelişme olasılığının yüksek olduğunu ve eşlik eden derin lenfopeninin mortalite ile doğrudan ilişkili olduğunu gözlemledik. Sonuçlar, yoğun bakım takibi sırasında, kötü prognostik faktörlerin etkileşime girerek daha ciddi prognostik sonuçlara yol açabileceğinin akılda tutulması gerektiğini vurgulamaktadır.

Kaynakça

  • World Health Organization. (‎2020)‎. Clinical management of COVID-19: interim guidance, World Health Organization, 2020.
  • Elder C, Bawa S, Anderson D, Atkinson S, Etzel J. Moritz T. Expectant management of pneumothorax in intubated COVID-19 positive patients: a case series. J Cardiothorac Surg 2020;15(1):263.
  • Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND, et. al. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J 2020;56(5):2002697.
  • Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res 2020;21(1):236.
  • Talan L, Şaşal Solmaz FG, Ercan U, Akdemir Kalkan İ, Yenigün BM, Yüksel C, et. al. COVID-19 pneumonia and pneumothorax: case series. Tuberk Toraks 2020;68(4):437-43.
  • Xu Y, Li S, Liu H. Clinical outcomes of pleural drainage on pneumothorax and hydrothorax in critically ill patients with COVID-19: A case series with literature review. Heart Lung 2021;50(2):213-19.
  • Ulutas H, Celik MR, Gulcek I, et al. Management of spontaneous pneumothorax in patients with COVID-19. Interact Cardiovasc Thorac Surg. 2022; 34 (6): 1002-1010. doi:10.1093/icvts/ivab280
  • Al-Ani A, AbuZayda H, Ahmed H, et al. Limitation of tube thoracostomy in treating pneumothorax in COVID-19 infected patients. A retrospective cohort study. Ann Med Surg (Lond). 2022;80:104171. doi:10.1016/j.amsu.2022.104171
  • Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020;58(7):1021-28.
  • Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci 2020;57(6):389-399.
  • Ciaccio M, Agnello L. Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis (Berl) 2020;7(4):365-72.
  • Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13
  • Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Analysis of 92 deceased patients with Covid-19. J Med Virol 2020; 92: 2511–15.
  • Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020;215:87–93.
  • Pieracci FM, Burlew CC, Spain D, Livingston DH, Bulger EM, Davis KA et al. Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees. Trauma Surg Acute Care Open 2020;5:e000498.
  • Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8(4):e26. doi: 10.1016/S2213-2600(20)30103-X]. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5
  • Gomersall CD, Joynt GM, Lam P, et al. Short-term outcome of critically ill patients with severe acute respiratory syndrome. Intensive Care Med. 2004;30(3):381-387. doi:10.1007/s00134-003-2143-y
  • Yarmus L, Feller-Kopman D. Pneumothorax in the critically ill patient. Chest. 2012;141(4):1098-1105. doi:10.1378/chest.11-1691
  • Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020. doi:10.1093/cid/ciaa248.
  • Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19. J Infect 2020;80:607–13.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Bulaşıcı Hastalıklar, Yoğun Bakım
Bölüm Original Article
Yazarlar

Tuba Şahinoğlu 0000-0002-1085-4865

Erken Görünüm Tarihi 27 Ekim 2024
Yayımlanma Tarihi 31 Ekim 2024
Gönderilme Tarihi 28 Aralık 2023
Kabul Tarihi 17 Eylül 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 34 Sayı: 5

Kaynak Göster

Vancouver Şahinoğlu T. The Relationship Between Pneumothorax and Lymphopenia In Patients with Covid-19 Pneumonia. Genel Tıp Derg. 2024;34(5):616-23.