Pneumomediastinum in COVID-19: Risk factors and outcomes from a multicentre case-control study

Area of Science:

• Pulmonology
• Infectious Diseases
• Critical Care Medicine

Background:

• An increased incidence of pneumomediastinum has been observed in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia.
• Pneumomediastinum is a serious complication that can affect patient outcomes.

Purpose of the Study:

• To identify risk factors associated with COVID-19-associated pneumomediastinum.
• To investigate the impact of pneumomediastinum on clinical outcomes in COVID-19 patients.

Main Methods:

• A multicentre retrospective case-control study was conducted.
• Patients with COVID-19 pneumonia and pneumomediastinum were compared to a control group without pneumomediastinum.
• Risk factors were assessed using multivariable logistic analysis.

Main Results:

• 139 patients with pneumomediastinum and 153 controls were analyzed.
• Risk factors included extensive lung involvement (≥75%), consolidations, low BMI (<22 kg/m²), high CRP (>150 mg/L), elevated D-dimer (>3000 ng/mL FEUs), and smoking history (>20 pack-years).
• Pneumomediastinum patients experienced longer hospital stays (31.2 vs 19.6 days), higher intubation rates (52.5% vs 17.6%), and increased in-hospital mortality (48.9% vs 23.5%).

Conclusions:

• Extensive lung parenchyma involvement, consolidations, low BMI, high inflammatory markers, and tobacco exposure are associated with an increased risk of pneumomediastinum in COVID-19 pneumonia.
• Pneumomediastinum significantly worsens clinical outcomes, including prolonged hospitalization, higher need for mechanical ventilation, and increased mortality.