Pneumothorax: Classification and Etiology

Comparison of lung ultrasound assisted by artificial intelligence to radiology examination in pneumothorax

BACKGROUND

Lung ultrasound can evaluate for pneumothorax but the accuracy of diagnosis depends on experience among physicians. This study aimed to investigate the sensitivity and specificity of intelligent lung ultrasound in comparison with chest x-ray, employing chest computed tomography (CT) as the gold standard for diagnosis of pneumothorax in critical ill patients.

METHODS

This prospective, observational study included 75 dyspnea patients admitted to the Intensive Care Unit of the Fourth Affiliated Hospital of Soochow University from January 2021 to April 2023. Lung ultrasound images were collected using BLUE-plus protocol and analyzed by artificial intelligence software to identify the pleural line, with CT results serving as the gold standard for diagnosis. Pneumothorax was diagnosed based on either the disappearance of pleural slip sign or identification of lung point. Additionally, chest x-ray images and diagnostic results were also obtained during the same period for comparison.

RESULTS

The sensitivity and specificity of intelligent lung ultrasound in diagnosing pneumothorax were 79.4% and 85.4%, respectively. The sensitivity and specificity of x-ray diagnosis were 82.4% and 80.5%. Additionally, the diagnostic time for lung ultrasound was significantly shorter than that for x-ray examination.

CONCLUSION

Intelligent lung ultrasound has diagnostic efficiency comparable to that of x-ray examination but offers advantages in terms of speed.

Retreatment after primary spontaneous pneumothoraxes managed with primary tube thoracostomy or surgery

BACKGROUND AND AIMS

There is a paucity of data on later healthcare visits and retreatments after primary treatment of spontaneous pneumothorax. The main purpose of this study was to describe retreatment rates up to 5 years after primary spontaneous pneumothorax treated with either surgery or tube thoracostomy (TT) at index hospitalization in Finland between 2005 and 2018 to estimate the burden of primary spontaneous pneumothorax on the healthcare system.

METHODS

Retrospective registry-based study of patients with primary spontaneous pneumothorax treated with TT or surgery in Finland in 2005-2018. Rehospitalization and retreatment for recurrent pneumothorax and complications attributable to initial treatment were identified.

RESULTS

The total study population was 1594 patients. At 5 years, 53.2% (384/722) of TT treated and 33.8% (295/872) of surgically treated patients had undergone any retreatment. Surgery was associated with a lower risk of recurrence than TT (hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.43-0.56, p < 0.001). Male sex was associated with a lower risk of recurrent treatment (HR 0.75, 95% CI 0.63-0.90, p = 0.001). Higher age decreased the risk of recurrent treatment (HR 0.99, 95% CI 0.99-0.99, p < 0.001). At 5 years, 36.0% (260/722) of the TT treated and 18.8% (164/872) of the surgically treated had undergone reoperation at some point.

CONCLUSIONS

Reintervention rates and repeat hospital visits after TT and surgery were surprisingly high at long-term follow-up. Occurrences of retreatment and reoperation were significantly higher among primary spontaneous pneumothorax patients treated with TT at index hospitalization than among patients treated with surgery.

Synchronous pneumothorax and venous thromboembolism after body contouring surgery

INTRODUCTION

Lipoabdominoplasty is one of the most common abdominal body contouring procedures performed today; however, it carries the risk of significant complications. Pneumothorax is a rare complication of liposuction, while, venous thromboembolism has a low short-term mortality and long-term morbidity.

PRESENTATION OF CASE

A 57-year-old woman with a history of diabetes mellitus, hypertension, obesity, and severe COVID-19 three years earlier. The patient underwent 360-degree liposuction and abdominoplasty. In the immediate postoperative period, the patient developed a right pneumothorax and followed by deep vein thrombosis (DVT) and pulmonary embolism (PE), which were diagnosed and treated early. After six months of follow-up, the patient presented a complete recovery.

DISCUSSION

Pneumothorax is recognized as a rare complication of liposuction and has been limited to case reports and small case series in the medical literature with an incidence of 0.04 %. In plastic and aesthetic surgery, body contouring procedures such as lipoabdominoplasty are associated with a risk of DVT and PE of 0.2-0.6 %, and 0.3 %, respectively. In addition, we believe that performing combined aesthetic procedures may increase the risk of complications.

CONCLUSION

This is the first reported case of pneumothorax, DVT and PE after body contouring surgery. We highlight the importance of awareness of these complications and the need for a high index of suspicion for early diagnosis and treatment, which is critical for patient survival.

The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan

INTRODUCTION

Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group.

METHODS

In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls.

RESULTS

We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities.

CONCLUSION

Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7-86.3% of cases, followed by pulmonary (1.8-12.8%), gastrointestinal (0.3-9.3%), psychogenic (5.1-83.6%), and cardiac chest pain (0.3-8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.

Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

A 45-year-old male with tongue cancer and obstructive sleep apnea presented for glossectomy and right neck dissection. He underwent a difficult nasal intubation assisted by a bougie and Glidescope. After an otherwise uneventful procedure, the patient was extubated and taken to recovery. Several hours later, he developed increased respirations and decreased oxygen (O2) saturation with decreased air movement on the right side of his chest. A chest X-ray confirmed a right pneumothorax. A chest tube was placed with immediate improvement of O2 saturation and breathing. Pneumothorax was presumably due to trauma from intubation. Although pneumothorax is a potential complication of intubation, it is more likely to occur shortly following intubation instead of hours later. The mechanism is often unknown. Providers must monitor patients throughout the perioperative period for any potential respiratory concerns, especially following a difficult intubation. This will ensure prompt diagnosis and management of any complications and provide an optimal outcome for the patient.

Secondary Spontaneous Pneumothorax in a Patient With Interstitial Lung Disease Undergoing Routine Outpatient Pulmonary Function Tests

We present the case of a 64-year-old female with a past medical history significant for unclassified interstitial lung disease (ILD) from suspected hypersensitivity pneumonitis secondary to chronic mold exposure with steroid responsiveness and prior pneumothorax. The patient developed shortness of breath and pleuritic chest pain after undergoing routine outpatient pulmonary function tests (PFTs). She was immediately transferred to the emergency department and found to have a moderate left basilar pneumothorax. She underwent emergent surgical chest tube placement followed by doxycycline pleurodesis. Repeat chest imaging showed inadvertent retraction of the chest tube and extensive subcutaneous emphysema. The surgical chest tube was replaced by a pigtail catheter with an improvement of subcutaneous emphysema. This case demonstrates the development of a rare but serious complication of pneumothorax that could occur in patients who have ILD undergoing routine PFTs. Clinicians should be aware of this risk when patients who have ILD present for PFTs and counsel them to seek immediate medical attention if they develop signs of acute onset dyspnea after performing PFTs.

Pneumothorax with liposuction, awareness of rare complication: a case report

BACKGROUND

Liposuction is the most commonly performed procedure in aesthetic plastic surgery worldwide, the complications and morbidity are under evaluated. Pneumothorax is thought to be a rare complication after liposuction but the exact rate still unknown.

CASE PRESENTATION

We presented to you a 45-year-old Arabian female with history of hypertension underwent lipoabdominoplasty, back liposuction and gluteal lipofilling. On the first postoperative day, the patient was complaining of chest pain accompanied with tachypnea and tachycardia, oxygen saturation was maintained on room air. Upon chest auscultation, diminished air entry was markedly noted on her left side, immediate chest x-ray and electrocardiogram (ECG) was done, which showed unremarkable x-ray and ECG shows sinus tachycardia. Computed tomography (CT) carried out and showed left side pneumothorax. An urgent thoracic surgery consultation was done and chest tube was inserted. The patient reported immediate improvement of her symptoms and the vital signs retain to normal range. On day 3, air leak stopped, chest tube was clipped by thoracic surgery, and the chest tube was removed 24 h later. The patient had a relatively smooth recovery with no other complications.

CONCLUSION

Pneumothorax have possibility to happen with liposuction, awareness of possible risk factors should detect by plastic surgeon, to manage earlier as soon as possible.

A Case of Bilateral Pneumothorax With COVID-19 Infection

Bilateral spontaneous pneumothorax is a serious complication of coronavirus disease 2019 (COVID-19). The incidence of any spontaneous pneumothorax in patients with the aforementioned viral infection when hospitalized is about 1%. Treatment can involve management such as oxygen support, tube thoracostomy, pleurodesis, or even invasive surgery. The associated mortality with this complication is about 33% to 52%. We present a case of bilateral pneumothorax in a patient diagnosed with COVID-19 without any history of smoking or underlying lung disease. Careful vigilance and close monitoring of this serious complication are mandatory in inpatients.

Risk factors and clinical features for pulmonary paragonimiasis-associated pneumothorax

BACKGROUND

Pulmonary paragonimiasis, a food-borne zoonotic helminthiasis, is a parasitic disease of the lung caused by infection with trematodes species of the genus Paragonimus. Although pneumothorax has been reported as occuring with paragonimiasis, to date no study has been performed concerning the clinical features and predictive risk factors for this condition.

METHODS

This retrospective study, which aims to fill this gap, was conducted at Jeonbuk National University Hospital. All patients (aged ≥19 years) were diagnosed with paragonimiasis between May 2011 and December 2021. Medical records were reviewed and information concerning age, sex, vital signs, underlying diseases, clinical signs and symptoms, laboratory findings, radiologic findings, treatment, and clinical outcomes was collected. An odds ratio (OR) for the risk factors associated with pneumothorax was calculated using the binary logistic regression model.

RESULTS

Among 179 consecutive patients diagnosed with pulmonary paragonimiasis, the postive rate of pneumothorax was 10.6% (19/179). Pneumothorax occurred mostly in the right lung (78.9%, 15/19), and intrapulmonary parenchymal lesions showed an ipsilateral relationship with pneumothorax (94.7%, 18/19). Fifteen patients (78.9%, 15/19) of pneumothorax associated with pulmonary paragonimiasis are accompanied by pleural effusion. Most of patients with pneumothorax (89.5%, 17/19) underwent chest tube insertion as a first treatment. Three patients (15.8%) showed relapses but in no case was a death recorded. Asthma (odds ratio [OR] 8.10, 95% confidence interval [CI] 1.43-45.91), chest pain (OR 8.15, 95% CI 2.70-24.58), and intrapulmonary lesions (OR 8.94, 95% CI 1.12-71.36) were independent risk factors for pulmonary paragonimiasis-associated pneumothorax.

CONCLUSIONS

Our findings suggest that clinicians should keep in mind the possibility of pneumothorax when approached by patients with pulmonary paragonimiasis complaining of chest pain, accompanied by intrapulmonary lesions or with asthma as an underlying disease.

Closed thoracic drainage in elderly patients with chronic obstructive pulmonary disease complicated with spontaneous pneumothorax: A retrospective study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) combined with spontaneous pneumothorax, is characterized by significant decline in lung function, and even cause cardiopulmonary failure and hypoxia.

AIM

To evaluate the clinical effectiveness of central venous catheters and indwelling pleural catheters (IPC) in managing closed thoracic drainage in patients diagnosed with COPD with concomitant by spontaneous pneumothorax.

METHODS

Retrospective analysis was conducted on the clinical information of 60 elderly patients with COPD complicated by spontaneous pneumothorax admitted to the Shexian Branch of the second affiliated hospital of Zhejiang university school of medicine between March 2020 and March 2023. The clinical efficacy, complications, hospitalization duration, and costs were compared between patients with an indwelling thoracic catheter and those with a central venous catheter. Univariate logistic regression was used to analyze the causes of catheter displacement.

RESULTS

According to our findings, there were significant differences in the IPC group's clinical efficacy, catheter operation time, and lung recruitment time (P < 0.05). Comparing the complications after catheter treatment between the two groups revealed statistically significant variations in the incidence of postoperative analgesics, catheter abscission, catheter blockage, and subcutaneous emphysema in the IPC group (P < 0.05). Univariate analysis demonstrated significant differences between patients with and without catheter dislodgement regarding duty nurse's working years (less than three), Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (less than 15), lack of catheter suture fixation, and the proportion of catheters not fixed twice (P < 0.05).

CONCLUSION

Our results demonstrated that when treating elderly COPD patients with spontaneous pneumothorax, indwelling thoracic catheters are more effective than the central venous catheter group. Patients' catheter shedding is influenced by the primary nurse's working years, APACHE II scores, and catheter fixation technique.

Automatic and efficient pneumothorax segmentation from CT images using EFA-Net with feature alignment function

Pneumothorax is a condition involving a collapsed lung, which requires accurate segmentation of computed tomography (CT) images for effective clinical decision-making. Numerous convolutional neural network-based methods for medical image segmentation have been proposed, but they often struggle to balance model complexity with performance. To address this, we introduce the Efficient Feature Alignment Network (EFA-Net), a novel medical image segmentation network designed specifically for pneumothorax CT segmentation. EFA-Net uses EfficientNet as an encoder to extract features and a Feature Alignment (FA) module as a decoder to align features in both the spatial and channel dimensions. This design allows EFA-Net to achieve superior segmentation performance with reduced model complexity. In our dataset, our method outperforms various state-of-the-art methods in terms of accuracy and efficiency, achieving a Dice coefficient of 90.03%, an Intersection over Union (IOU) of 81.80%, and a sensitivity of 88.94%. Notably, EFA-Net has significantly lower FLOPs (1.549G) and parameters (0.432M), offering better robustness and facilitating easier deployment. Future work will explore the integration of downstream applications to enhance EFA-Net's utility for clinicians and patients in real-world diagnostic scenarios. The source code of EFA-Net is available at: https://github.com/tianjiamutangchun/EFA-Net .

Traumatic occult pneumothorax and ipsilateral hydatid cyst: A case report

INTRODUCTION

Traumatic pneumothorax is a common chest condition that can be caused by a chest trauma. Hydatid cysts are also common, especially in Syria, and is caused by Echinococcus granulosis infection.

CASE PRESENTATION

We report a case of mutual presentation of pneumothorax and a large Hydatid cyst on the same chest side in an 18 years-old patient who got stabbed in the chest. The chest x-ray reveled well-defined, homogeneous radio-opacity lesion that is consistent with Hydatid cyst but no pneumothorax was observed. Later, the chest CT showed a small pneumothorax that coexist with the Hydatid cyst. The case was treated conservatively and the patient survived.

DISCUSSION

Some studies support treating asymptomatic trauma patients with occult PT with observation and placing a chest tube if still asymptomatic. Our case questions the management protocol for such a rare encounter as the stability status of the patient was poor, and there was a large hydatid cyst close to the chest wall.

CONCLUSION

Physicians should be aware of the possible management solutions when dealing with similar cases, especially in emergency settings. Until clear guidelines are published for this matter, we recommend that high-level observation of the patient's vitals are the determining factor for suitable intervention.

DAWTran: dynamic adaptive windowing transformer network for pneumothorax segmentation with implicit feature alignment

Objective. This study aims to address the significant challenges posed by pneumothorax segmentation in computed tomography images due to the resemblance between pneumothorax regions and gas-containing structures such as the trachea and bronchus.Approach. We introduce a novel dynamic adaptive windowing transformer (DAWTran) network incorporating implicit feature alignment for precise pneumothorax segmentation. The DAWTran network consists of an encoder module, which employs a DAWTran, and a decoder module. We have proposed a unique dynamic adaptive windowing strategy that enables multi-head self-attention to effectively capture multi-scale information. The decoder module incorporates an implicit feature alignment function to minimize information deviation. Moreover, we utilize a hybrid loss function to address the imbalance between positive and negative samples.Main results. Our experimental results demonstrate that the DAWTran network significantly improves the segmentation performance. Specifically, it achieves a higher dice similarity coefficient (DSC) of 91.35% (a larger DSC value implies better performance), showing an increase of 2.21% compared to the TransUNet method. Meanwhile, it significantly reduces the Hausdorff distance (HD) to 8.06 mm (a smaller HD value implies better performance), reflecting a reduction of 29.92% in comparison to the TransUNet method. Incorporating the dynamic adaptive windowing (DAW) mechanism has proven to enhance DAWTran's performance, leading to a 4.53% increase in DSC and a 15.85% reduction in HD as compared to SwinUnet. The application of the implicit feature alignment (IFA) further improves the segmentation accuracy, increasing the DSC by an additional 0.11% and reducing the HD by another 10.01% compared to the model only employing DAW.Significance. These results highlight the potential of the DAWTran network for accurate pneumothorax segmentation in clinical applications, suggesting that it could be an invaluable tool in improving the precision and effectiveness of diagnosis and treatment in related healthcare scenarios. The improved segmentation performance with the inclusion of DAW and IFA validates the effectiveness of our proposed model and its components.

Spontaneous Pneumothorax: Controversies in Treatment

The Research to Practice column critiques a current research article and translates the findings, in the context of a case, to a practice change within emergency settings. This article reviews the findings of a randomized controlled trial conducted by A. Theille et al. (2017) comparing the use of needle decompression versus chest tube insertion for management of spontaneous pneumothorax. The study found that use of needle aspiration was safe and effective and was associated with fewer procedure-related complications and significantly shorter hospital stays. The investigators concluded that needle aspiration be used as a first-line, definitive treatment in management of a spontaneous pneumothorax. As emergency providers examine improved and equally effective approaches to care that are associated with less costs and potential complications, needle aspiration offers a beneficial approach and should be shared with patients when discussing treatment options to ensure shared decision making.

Manejo quirúrgico del neumotórax espontáneo primario. Encuesta nacional del Grupo Emergente de Cirugía Torácica de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR)

Introduction

In February 2022, the Emerging Thoracic Surgery Group of the Spanish Society of Pneumology and Thoracic Surgery initiated a multicenter study on the surgical management of primary spontaneous pneumothorax (PSP). As a preliminary step, this survey was developed with the aim of finding out the current situation in our country to specify and direct this project.

Method

A descriptive study was carried out based on the results of this survey launched through the Google Docs® platform. The survey was sent to all active national thoracic surgeons, a total of 319. It consisted of 20 questions including demographic, surgical and follow-up data.

Results

We obtained 124 responses (39% of all specialists and doctors in training in the national territory). The most consistent indications were: homolateral recurrence for 124 (100%), lack of resolution of the episode for 120 (96.7%), risk professions for 104 (84%) and bilateral pneumothorax for 93 (75%). The approach of choice for 100% of respondents was videothoracoscopy. Of these, 96 contemplated pulmonary resection of obvious lesions (77%). Regarding the pleurodesis technique, pleural abrasion was the technique most used by 70 respondents (56.7%) while 49 (40%) performed chemical pleurodesis with talc either alone or in combination with mechanical pleurodesis.

Conclusions

While there is some consistency in some aspects of surgical management of PSP, this survey makes evident the variability in pleurodesis techniques applied among surgeons in our country.

Endpoints in Vital Signs as a Useful Tool for Measuring Successful Needle Decompression After Traumatic Tension Pneumothorax: An Analysis of the National Emergency Medicine Information System Database

Background Needle decompression is a useful tool in the pre-hospital setting for treating tension pneumothorax. However the specific improvements in vital signs that determine a successful decompression are only reported in a few studies and Emergency Medical Services (EMS) self-reported assessments of improvement are more commonplace. We hypothesize that EMS reports may exaggerate improvement when compared to objective vital sign changes. Methodology This is a retrospective cohort study using the National Emergency Medicine Information System (NEMSIS) for the year 2020. Vital signs recorded as objective endpoints include systolic blood pressure (SBP), pulse (HR), respiratory rate (RR), and oxygen saturation (SpO₂). Univariate analysis was performed using the t-test for continuous variables and the chi-square test for categorical variables. Results A total of 8,219 calls were included in the sample size analyzed. Most patients were white (2,911, 35.4%) and male (6,694, 81.4%). Abnormal vitals recorded as indications for needle decompression included SBP <100 mmHg, HR <60 or >100 beats/minute, RR <12 or >20 breaths/minute, and SpO₂ <93%. Statistically significant improvements were seen in the number of abnormal vital signs after the procedure. The percentage of improvement was higher in the EMS self-reported assessment than in objective findings for oxygen saturation and SBP. Conclusions Our analysis shows objective improvement of hypoxia and hypotension after field needle decompression, supporting the efficacy of the procedure. The improvement based on vital sign change is modest and is less than that reported by EMS assessment of global improvement. This represents a target for quality improvement in EMS practice.

Risk of diaphragmatic hernia in patients with spontaneous pneumothorax

Background

Few studies have implied the incidence of diaphragmatic hernia (DH) after spontaneous pneumothorax (SP) with unknown mechanisms. The current study aimed to identify whether there is an association between the DH and SP.

Methods

We selected 46,897 patients with SP (SP cohort) and 46,897 without SP (non-SP matched cohort) from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence of DH and its association with SP were assessed after stratifying different characteristics and comorbidities. Statistical analysis including chi-square test, t-test, cox proportional hazard model, and Kaplan–Meier method were used.

Results

The results suggested there were significant associations between SP and DH, especially in the subgroup of patients with older age (aged 40–64 years: 2.61-fold in adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.27–5.36; aged > 65 years: 1.97-fold in aHR, 95% CI 1.43–2.71), male sex (2.11-fold in aHR, 95% CI 1.56–2.85), hypertension (2.05-fold in aHR, 95% CI 1.30–3.23), diabetes mellitus (2.58-fold in aHR, 95% CI 1.37–4.86), and smoking-related disease (1.86-fold in aHR, 95% CI 1.28–2.71). The SP cohort has significantly correlated with DH within 5-year follow-up (< 2 years: 3.22-fold in aHR, 95% CI 2.10–4.94; 2–5 years: 1.70-fold in aHR, 95% CI 1.05–2.75).

Conclusions

The SP cohort had a higher incidence of DH than the non-SP matched cohort. A prospective study of indications based on the findings of the current research should be performed.