Association Between BMI and Recurrence of Primary Spontaneous Pneumothorax

Abstract

BackgroundWhether body mass index (BMI) is a significant risk factor for recurrence of primary spontaneous pneumothorax (PSP) remains controversial. The purpose of this study was to examine whether BMI and other factors are linked to risk of PSP recurrence.MethodsA consecutive cohort of 273 patients was retrospectively evaluated. Patients were divided into those who experienced recurrence (n = 81) and those who did not (n = 192), as well as into those who had low BMI (n = 75) and those who had normal or elevated BMI (n = 198). The two pairs of groups were compared in terms of baseline data, and Cox proportional hazards modeling was used to identify predictors of PSP recurrence.ResultsRates of recurrence among all 273 patients were 20.9% at 1 year, 23.8% at 2 years, and 28.7% at 5 years. Univariate analysis identified the following significant predictors of PSP recurrence: height, weight, BMI, size of pneumothorax, and treatment modality. Multivariate analyses identified several risk factors for PSP recurrence: low BMI, pneumothorax size ≥50%, and non-surgical treatment. Kaplan–Meier survival analysis indicated that patients with low BMI showed significantly lower recurrence-free survival than patients with normal or elevated BMI (P < 0.001).ConclusionsLow BMI, pneumothorax size ≥50%, and non-surgical treatment were risk factors for PSP recurrence in our cohort. Low BMI may be a clinically useful predictor of PSP recurrence.

Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis

“…Low BMI is an established risk factors for the initial development of PSP [42,43]. While two studies demonstrated increased risk of recurrence with low weight and BMI, respectively, differing classifications precluded meta-analysis [5,6]. The hypothesis that PSP recurrence is linked with low body weight, either…”

“…Clinical study AL-ALAWI [17] AL-MOURGI [18] ANDERSEN [19] CASALI [10] CHAN [12] CHEN [20] CHEN [21] CHEN [22] GANESALINGAM [9] HARVEY [23] KARASAKI [25] KIM [26] KUAN [27] LICHTER [28] LIGHT [29] MARTÍNEZ-RAMOS [30] MEHTA [31] NISHIUMA [32] NOH [33] NOH [34] OLESEN [6] OUANES-BESBES [13] PRIMAVESI [8] SADIKOT [ due to nutritional deficiencies affecting α 1 -antitrypsin levels or due to unbalanced physical development, was supported by two papers [5,6,[44][45][46].…”

“…Factors associated with recurrence 12 observational studies examined the association between sex and PSP recurrence [4-6, 8-10, 13, 17, 24, 31, 33, 34], with eight demonstrating increased recurrence rates in females [4-6, 9, 10, 13, 16, 32]. Odd ratios could be determined from seven studies [4,5,9,13,17,31,33], with random effects meta-analysis demonstrating OR 3.03 (95% CI 1.24-7.41; p=0.015) for female sex (figure 3). Four studies reported hazard ratios for sex and meta-analysis yielded an estimated HR 1.2 (95% CI 0.83-1.67; p=0.35) associated with being female [6,[8][9][10].…”

“…Eight observational studies examined BMI or weight [4-6, 8, 10, 17, 33, 34], with two demonstrating a significant association between low BMI/weight and recurrence [5,6]. 13 studies examined whether age correlated with recurrence, with 10 studies finding no association [4-6, 8-10, 12, 13, 17, 26, 38].…”

“…Unfortunately, there are no established factors that predict recurrence and consequently no method for risk-stratifying patients. Female sex, low body weight, smoking and height in males have all been postulated as risk factors for recurrence [4][5][6][7]. Certain radiographic features have also been suggested to confer additional risk, including bullae on computed tomography (CT) and pleural thickening on chest radiography [8][9][10].…”