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Irish Journal of Medical Science (1971 -)

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18-09-2021 | Pneumothorax | Original Article

The relationship between mortality and inflammatory markers and the systemic immune inflammatory index in patients in the intensive care unit with a pneumothorax as a complication of COVID-19 disease

Published in: Irish Journal of Medical Science (1971 -) | Issue 4/2022

Abstract

Background

A pneumothorax is common in patients admitted to the intensive care unit (ICU) with coronavirus disease (COVID-19) when non-invasive or invasive mechanical ventilation is performed to maintain adequate oxygenation. The aim of the present study was to investigate the effects of elevated inflammatory markers and an elevated systemic immune inflammatory index (SII) on mortality in this patient population.

Materials and methods

Between March 2020 and May 2021, 124 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reacion positviity who were admitted to the ICU in our hospital and diagnosed with and treated for a pneumothorax were evaluated retrospectively. Interleukin-6 (IL-6), C-reactive protein, neutrophil, lymphocyte, platelet and white blood cell levels were measured. These parameters were used to calculate the neutrophil–lymphocyte ratio (NLR) and SII, and the association of these parameters with pneumothorax-related mortality was examined.

Results

This study included 39 female (31.5%) and 85 male (68.5%) patients. The mean age was 65.3 ± 12.6 years. Non-invasive mechanical ventilation was performed in 13 (10.5%) patients, and 111 (89.5%) patients received invasive mechanical ventilation. Tube thoracostomy was performed in 113 patients (91.1%), and 11 patients (8.9%) were treated with oxygen therapy. The factors affecting mortality in the pneumothorax patients were the Charlson Comorbidity Index (four or higher), IL-6 level and NLR. The IL-6 level was 53.4 in those who died versus 24.6 in those who survived (p = 0.017). The NLR in the patients who died was 16.9 as compared to 12.5 in those who survived (p = 0.011).

Conclusion

Elevated markers of infection were associated with an increased risk of mortality in pneumothorax patients with COVID-19 who received invasive or non-invasive mechanical ventilation in the ICU. In this patient population, high levels of positive end-expiratory pressure should be avoided, and inflammatory marker levels and the SII should be closely monitored.

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Title: The relationship between mortality and inflammatory markers and the systemic immune inflammatory index in patients in the intensive care unit with a pneumothorax as a complication of COVID-19 disease
Publication date: 18-09-2021
Keywords: Pneumothorax
Pneumothorax
Pneumothorax
SARS-CoV-2
Care
COVID-19
Published in: Irish Journal of Medical Science (1971 -) / Issue 4/2022
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI: https://doi.org/10.1007/s11845-021-02740-x

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Abstract

Background

Materials and methods

Results

Conclusion

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