Smoking Prevalence among Severe and Critical Cases of COVID 19 Patients in Sulaimani/ Single Center Study

Authors

  • Bakhtyar Qadr Hama Khurshid ( MBCHB, FKBMS ) Department of critical care medicine, Shar Teaching Hospital/ Sulaymaniyah/ Iraq
  • Haval Othman Ali ( MBCHB, CABD, FIBMS ) Department of Critical Care Medicine, Shar Teaching Hospital, Sulaymaniyah, Iraq

Keywords:

COVID-19, Smoking, Mortality

Abstract

Background and Objectives: Smoking is a known risk factor for various respiratory infections and
diseases. However, its impact on the severity and outcomes of COVID-19 remains a subject of
ongoing research. The objective is to evaluate if smoking is linked to mortality in COVID-19
patients.
Methods: A retrospective cohort study was conducted on the ICU admitted COVID-19 patients,
between May, 2020 and July, 2021. Admitted patients to the hospital with positive Severe acute
respiratory sendrom-2 were categorized based on smoking status. The main focus was on mortality
during hospitalization. Odds ratios (OR) and 95% confidence intervals (95%CI) were presented for
smoking status.
Results: Among 400 COVID-19 deaths (mean age was 61.2 ± 13.0 years), the majority was
between 60-60 years (35.3%, n=141), followed by older than 70 years (27.7%, n=111) then 50-59
years (17.7%, n=71), then 40-49 years (12.3%, n=49), only 7.0% (n=28) was < 40 years. The
majority was male (62.2%, n=249) rather than female (37.8%, n=151). Mean ICU stay was 9.3 ±
10.7 days. 59.5% have at least one comorbidity. The prevalence of active smoker =1.8% vs 5.3%;
former smoker= 28.7% vs 22.1%; and never smoker= 69.5% vs 72.5% regarding death and
discharged patients. AS has lower risk of mortality (OR= 0.36 (95%CI 0.13- 0.99; P =0.041) than
NS, The AS, as well as low risk of mortality (OR=0.29 (95%CI 0.11- 0.79; P = 0.0) than FS.
Indeed, the former smoker has higher risk mortality (OR was 1.25 (95%CI 0.88 - 1.78; P= 0.203)
than NS.
Conclusion: The older adults, males, comorbidity are at higher mortality risk by COVID-19
infection. Active smokers have lower in-ICU mortality than former smokers and never smokers,
While, the former smokers have higher risk of mortality than active smokers and never smokers.

References

Zhang H, Ma S, Han T, Qu G, Cheng C, Uy JP, et al. Association of smoking history with severe and

critical outcomes in COVID-19 patients: a systemic review and meta-analysis. European journal of integrative

medicine. 2021;43. doi. 10.1016/j.eujim.2021.101313.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with

pneumonia in China, 2019. New England journal of medicine. 2020;382(8). doi. 10.1056/NEJMoa2001017.

Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel

coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned?

International journal of epidemiology. 2020;49(3). doi. 10.1093/ije/dyaa033.

Organization WH. World Health Organization (WHO) Director-General’s Opening Remarks at the Media

Briefing on COVID-19. 2020.

Wang C, Wang Z, Wang G, Lau JY-N, Zhang K, Li W. COVID-19 in early 2021: current status and

looking forward. Signal transduction and targeted therapy. 2021;6(1). doi. 10.1038/s41392-021-00527-1.

Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease

in China. New England journal of medicine. 2020;382(18). doi. 10.1056/NEJMoa2002032.

Yadav V, Rajput M, Diwakar R, Kumar R. An Overview on Transmission of Diseases in Special

Reference to COVID-19 and Potential Targets to Control this Pandemic. J Adv Microbiol Res. 2020;4. doi.

24966/AMR-694X/100015.

Strzelak A, Ratajczak A, Adamiec A, Feleszko W. Tobacco smoke induces and alters immune responses

in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review. International

journal of environmental research and public health. 2018;15(5). doi. 10.3390/ijerph15051033.

Prinelli F, Bianchi F, Drago G, Ruggieri S, Sojic A, Jesuthasan N, et al. Association between smoking and

SARS-CoV-2 infection: cross-sectional study of the EPICOVID19 internet-based survey. JMIR public health and

surveillance. 2021;7(4). doi. 10.2196/27091.

Wang J, Luo Q, Chen R, Chen T, Li J. Susceptibility analysis of COVID-19 in smokers based on ACE2.

doi. 10.20944/preprints202003.0078.v1.

Oakes JM, Fuchs RM, Gardner JD, Lazartigues E, Yue X. Nicotine and the renin-angiotensin system.

American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2018;315(5). doi.

1152/ajpregu.00099.2018.

Piao W-H, Campagnolo D, Dayao C, Lukas RJ, Wu J, Shi F-D. Nicotine and inflammatory neurological

disorders. Acta Pharmacologica Sinica. 2009;30(6). doi. 10.1038/aps.2009.67.

Besaratinia A. COVID-19: a pandemic converged with global tobacco epidemic and widespread vaping—

state of the evidence. Carcinogenesis. 2021;42(8). doi. 10.1093/carcin/bgab061.

Norden MJ, Avery DH, Norden JG, Haynor DR. National smoking rates correlate inversely with COVID19 mortality. MedRxiv. 2020. doi. 10.1101/2020.06.12.20129825.

Gkoufa A, Maneta E, Ntoumas GN, Georgakopoulou VE, Mantelou A, Kokkoris S, et al. Elderly adults

with COVID-19 admitted to intensive care unit: A narrative review. World Journal of Critical Care Medicine.

;10(5). doi. 0.5492/wjccm.v10.i5.278.

Le Borgne P, Dellenbach Q, Alame K, Noizet M, Gottwalles Y, Chouihed T, et al. The impact of age on

in-hospital mortality in critically Ill COVID-19 patients: A retrospective and multicenter study. Diagnostics.

;12(3). doi. 10.3390/diagnostics12030666.

Nguyen NT, Chinn J, De Ferrante M, Kirby KA, Hohmann SF, Amin A. Male gender is a predictor of

higher mortality in hospitalized adults with COVID-19. PloS one. 2021;16(7). doi. 10.1371/journal.pone.0254066.

Meijs DA, van Bussel BC, Stessel B, Mehagnoul-Schipper J, Hana A, Scheeren CI, et al. Better COVID19 Intensive Care Unit survival in females, independent of age, disease severity, comorbidities, and treatment.

Scientific reports. 2022;12(1). doi. 10.1038/s41598-021-04531-x.

Prats-Uribe A, Xie J, Prieto-Alhambra D, Petersen I. Smoking and COVID-19 infection and related

mortality: a prospective cohort analysis of UK biobank data. Clinical Epidemiology. 2021. doi.

2147/CLEP.S300597. eCollection 2021.

Razjouyan J, Helmer DA, Lynch KE, Hanania NA, Klotman PE, Sharafkhaneh A, et al. Smoking status

and factors associated with COVID-19 in-hospital mortality among US veterans. Nicotine and Tobacco Research.

;24(5). doi. 10.1093/ntr/ntab223.

Neira DP, Watts A, Seashore J, Polychronopoulou E, Kuo Y-F, Sharma G. Smoking and risk of COVID19 hospitalization. Respiratory medicine. 2021;182. doi. 10.1016/j.rmed.2021.106414.

Martinez FJ, Han MK, Allinson JP, Barr RG, Boucher RC, Calverley PM, et al. At the root: defining and

halting progression of early chronic obstructive pulmonary disease. American journal of respiratory and critical

care medicine. 2018;197(12). doi. 10.1164/rccm.201710-2028PP.

Gao M, Aveyard P, Lindson N, Hartmann-Boyce J, Watkinson P, Young D, et al. Association between

smoking, e-cigarette use and severe COVID-19: a cohort study. International Journal of Epidemiology.

;51(4). doi. 10.1093/ije/dyac028.

Clift AK, Von Ende A, San Tan P, Sallis HM, Lindson N, Coupland CA, et al. Smoking and COVID-19

outcomes: an observational and Mendelian randomisation study using the UK Biobank cohort. Thorax.

;77(1).

Vleeming W, Rambali B, Opperhuizen A. The role of nitric oxide in cigarette smoking and nicotine

addiction. Nicotine & tobacco research. 2002;4(3). doi. 10.1080/14622200210142724.

Farsalinos K, Barbouni A, Poulas K, Polosa R, Caponnetto P, Niaura R. Current smoking, former

smoking, and adverse outcome among hospitalized COVID-19 patients: a systematic review and meta-analysis.

Therapeutic advances in chronic disease. 2020;11. doi. 10.1177/2040622320935765.

Rossato M, Di Vincenzo A. Cigarette smoking and COVID-19. Pulmonology. 2021;27(3). doi.

1016/j.pulmoe.2020.12.013

Downloads

Published

2024-06-12

Issue

Section

ARTICLE