{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:29:04Z","timestamp":1771331344852,"version":"3.50.1"},"reference-count":132,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax\/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax\/pneumomediastinum at presentation (n = 68), pneumothorax\/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax\/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (\u00b1pneumomediastinum). The overall mortality rate of pneumothorax\/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax\/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax\/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.<\/jats:p>","DOI":"10.3390\/jcm11237132","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T02:24:46Z","timestamp":1669861486000},"page":"7132","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prognosis of Spontaneous Pneumothorax\/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0053-4470","authenticated-orcid":false,"given":"Wongi","family":"Woo","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6946-8857","authenticated-orcid":false,"given":"Vincent","family":"Kipkorir","sequence":"additional","affiliation":[{"name":"Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi 00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-3168","authenticated-orcid":false,"given":"Adina Maria","family":"Marza","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1764-9514","authenticated-orcid":false,"given":"Shadi","family":"Hamouri","sequence":"additional","affiliation":[{"name":"Department of General Surgery & Urology, King Abdullah University Hospital, Jordan University of Science & Technology, Irbid 22110, Jordan"},{"name":"Department of General Surgery and Special Surgery, Faculty of Medicine, Al- Balqa\u2019 Applied University, Al-Salt 19117, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5591-127X","authenticated-orcid":false,"given":"Omar","family":"Albawaih","sequence":"additional","affiliation":[{"name":"Department of General Surgery & Urology, King Abdullah University Hospital, Jordan University of Science & Technology, Irbid 22110, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1794-2569","authenticated-orcid":false,"given":"Arkadeep","family":"Dhali","sequence":"additional","affiliation":[{"name":"Institute of Postgraduate Medical Education and Research, Kolkata 700020, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wooshik","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, National Medical Center, Seoul 04564, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zarir F.","family":"Udwadia","sequence":"additional","affiliation":[{"name":"Breach Candy Hospital and Research Center, Mumbai 400026, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4845-4119","authenticated-orcid":false,"given":"Abdulqadir J.","family":"Nashwan","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha 576214, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nissar","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Surgical Intensive Care Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha 576214, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-0565","authenticated-orcid":false,"given":"Alessandro","family":"Belletti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8594-5980","authenticated-orcid":false,"given":"Giovanni","family":"Landoni","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7906-540X","authenticated-orcid":false,"given":"Diego","family":"Palumbo","sequence":"additional","affiliation":[{"name":"Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarya","family":"Swed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Aleppo University, Aleppo 15310, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bisher","family":"Sawaf","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hamad General Hospital, Doha 576214, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8567-2639","authenticated-orcid":false,"given":"Danilo","family":"Buonsenso","sequence":"additional","affiliation":[{"name":"Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6522-8338","authenticated-orcid":false,"given":"In\u00eas","family":"Pimenta","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Hospital Garcia de Orta EPE, 2805-267 Almada, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8539-1092","authenticated-orcid":false,"given":"Filipe Andr\u00e9","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Hospital Garcia de Orta EPE, 2805-267 Almada, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2523-9769","authenticated-orcid":false,"given":"Giuseppe","family":"Fiorentino","sequence":"additional","affiliation":[{"name":"Sub-Intensive Care Unit and Respiratory Physiopathology Department, Cotugno-Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Redzwan S.","family":"Rashid Ali","sequence":"additional","affiliation":[{"name":"Kpj Johor Specialist Hospital, Johor Bahru 80100, 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(ICP-WG)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. 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