Risk factors and age-specific monthly patterns of primary spontaneous pneumothorax: a multicenter study

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Key findings

• Distinct monthly dynamics in primary spontaneous pneumothorax (PSP) incidence between individuals aged ≥20 years and those in their teens were found. We identified body mass index (BMI) and monocyte-lymphocyte ratio (MLR) as risk factors for PSP recurrence: BMI was a male sex-specific factor, whereas MLR applied to both sexes in patients aged more than 20 years.

What is known and what is new?

• Research on the occurrence and recurrence of PSP is limited, lacking comprehensive evaluations of PSP epidemiology and risk factors. Prior studies have established an association between BMI and PSP development, recognizing low BMI as a significant risk factor for recurrence. Additionally, although inflammatory status may play a role, studies investigating its relationship with PSP recurrence remain scarce.

• Our study highlighted that PSP incidence was mainly observed in patients in their late teenage years, with distinct differences in incidence and recurrence patterns compared with other age groups. Additionally, we found that BMI was significantly associated with PSP recurrence, consistent with prior findings indicating that low BMI increased recurrence risk. Notably, we observed that PSP could also occur in patients with normal BMI, suggesting that dynamic changes in body shape, such as rapid height growth followed by volume increase, might play a crucial role in PSP. Furthermore, we identified MLR as a novel and significant risk factor for PSP recurrence, emphasizing the role of systemic inflammation.

What is the implication, and what should change now?

• We observed distinct incidence patterns among teenagers compared with those in other age groups, warranting further investigation.

• Our findings linking BMI and inflammation status to pneumothorax recurrence offer valuable groundwork for future prospective studies aimed to establish preventive and effective treatment strategies.

Publication: Yoon SK, Kim HK, Lee J, Kim YD, Cho DG. Risk factors and age-specific monthly patterns of primary spontaneous pneumothorax: a multicenter study. J Thorac Dis 2025;17(3):1131-1141. doi: 10.21037/jtd-2024-1957