Retrospective analysis of COVID-19 patients developing otherwise rare complications

Over the last 2 years, it has been felt that there was a disproportionate incidence of complications including pneumothorax, pneumomediastinum, and renal disease necessitating dialysis in patients with COVID-19 as compared to patients without COVID-19.

In a retrospective cohort, all patients were admitted to St. Joseph Mercy Oakland Hospital in Pontiac, Michigan, between March 2020 and November 2021. The data collected included age, sex, BMI, length of stay, COVID-19 PCR result, diagnosis of pneumothorax, diagnosis of pneumomediastinum, diagnosis of renal failure, orders for dialysis, and orders for mechanical ventilation.

Nine thousand five hundred twenty-two patients are included in this study, with 35.6% (3,392 patients) COVID-19 suspected or confirmed positive and 64.4% (6130 patients) confirmed COVID-19 negative. There were 29 cases of pneumomediastinum and 24 cases of pneumothorax, none of which occurred in intubated patients. The incidence of pneumomediastinum (p = 0.001), CODE BLUE (p = 0.01), and mechanical ventilation (p = 0.001) was significantly higher in the COVID-19 positive/suspected group. There was no significant difference in incidence of pneumothorax (p = 0.294). The incidence of dialysis was significantly higher (p < 0.0001) in the COVID-19 negative group.

In review of prior literature and proposed mechanisms, we believe that it was possibly the damage that SARS-CoV-2 inflicts upon lung parenchyma that led to the increased incidence of pneumomediastinum. Given our mixed findings of incidences of pneumomediastinum, pneumothorax, and dialysis, our hope is to remain vigilant to uncover further disease associations and/or complications as more COVID-19 case data becomes available.