Impact of smoking on COVID-19 outcomes: a HOPE Registry subanalysis

Carolina Espejo-Paeres, Iván J Núñez-Gil, Vicente Estrada, Cristina Fernández-Pérez, Giovanna Uribe-Heredia, Clara Cabré-Verdiell, Aitor Uribarri, Rodolfo Romero, Marcos García-Aguado, Inmaculada Fernández-Rozas, Victor Becerra-Muñoz, Martino Pepe, Enrico Cerrato, Sergio Raposeiras-Roubín, María Barrionuevo-Ramos, Freddy Aveiga-Ligua, Carolina Aguilar-Andrea, Emilio Alfonso-Rodríguez, Fabrizio Ugo, Juan Fortunato García-Prieto, Gisela Feltes, Ibrahim Akin, Jia Huang, Jorge Jativa, Antonio Fernández-Ortiz, Carlos Macaya, Ana Carrero-Fernández, Jaime Signes-Costa, Carolina Espejo-Paeres, Iván J Núñez-Gil, Vicente Estrada, Cristina Fernández-Pérez, Giovanna Uribe-Heredia, Clara Cabré-Verdiell, Aitor Uribarri, Rodolfo Romero, Marcos García-Aguado, Inmaculada Fernández-Rozas, Victor Becerra-Muñoz, Martino Pepe, Enrico Cerrato, Sergio Raposeiras-Roubín, María Barrionuevo-Ramos, Freddy Aveiga-Ligua, Carolina Aguilar-Andrea, Emilio Alfonso-Rodríguez, Fabrizio Ugo, Juan Fortunato García-Prieto, Gisela Feltes, Ibrahim Akin, Jia Huang, Jorge Jativa, Antonio Fernández-Ortiz, Carlos Macaya, Ana Carrero-Fernández, Jaime Signes-Costa

Abstract

Background: Smoking has been associated with poorer outcomes in relation to COVID-19. Smokers have higher risk of mortality and have a more severe clinical course. There is paucity of data available on this issue, and a definitive link between smoking and COVID-19 prognosis has yet to be established.

Methods: We included 5224 patients with COVID-19 with an available smoking history in a multicentre international registry Health Outcome Predictive Evaluation for COVID-19 (NCT04334291). Patients were included following an in-hospital admission with a COVID-19 diagnosis. We analysed the outcomes of patients with a current or prior history of smoking compared with the non-smoking group. The primary endpoint was all-cause in-hospital death.

Results: Finally, 5224 patients with COVID-19 with available smoking status were analysed. A total of 3983 (67.9%) patients were non-smokers, 934 (15.9%) were former smokers and 307 (5.2%) were active smokers. The median age was 66 years (IQR 52.0-77.0) and 58.6% were male. The most frequent comorbidities were hypertension (48.5%) and dyslipidaemia (33.0%). A relevant lung disease was present in 19.4%. In-hospital complications such sepsis (23.6%) and embolic events (4.3%) occurred more frequently in the smoker group (p<0.001 for both). All cause-death was higher among smokers (active or former smokers) compared with non-smokers (27.6 vs 18.4%, p<0.001). Following a multivariate analysis, current smoking was considered as an independent predictor of mortality (OR 1.77, 95% CI 1.11 to 2.82, p=0.017) and a combined endpoint of severe disease (OR 1.68, 95% CI 1.16 to 2.43, p=0.006).

Conclusion: Smoking has a negative prognostic impact on patients hospitalised with COVID-19.

Keywords: COVID-19; infectious disease; pulmonary disease.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
All-cause in-hospital death according to smoking status, stratified by age.
Figure 3
Figure 3
Kaplan-Meier survival curve free from all-cause death, according to smoking status.

References

    1. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. Available:
    1. Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020;92:552–5. 10.1002/jmv.25728
    1. Cao Y, Liu X, Xiong L, et al. . Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis. J Med Virol 2020;92:1449–59. 10.1002/jmv.25822
    1. Guan W-J, Ni Z-Y, Hu Y, et al. . Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20. 10.1056/NEJMoa2002032
    1. Zhao Q, Meng M, Kumar R, et al. . The impact of COPD and smoking history on the severity of COVID-19: a systemic review and meta-analysis. J Med Virol 2020;92:1915–21. 10.1002/jmv.25889
    1. Liu W, Tao Z-W, Wang L, et al. . Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J 2020;133:1032–8. 10.1097/CM9.0000000000000775
    1. Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med 2020;75:107–8. 10.1016/j.ejim.2020.03.014
    1. Miyara M, Tubach F, Martinez V. Low rate of daily smokers in patients with symptomatic COVID-19. medRxiv 2020.
    1. Huang C, Wang Y, Li X, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020;395:497–506. 10.1016/S0140-6736(20)30183-5
    1. Yang X, Yu Y, Xu J, et al. . Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475–81. 10.1016/S2213-2600(20)30079-5
    1. Zhang J-J, Dong X, Cao Y-Y, et al. . Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020;75:1730–41. 10.1111/all.14238
    1. Mo P, Xing Y, Xiao Y, et al. . Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis 2020;270. 10.1093/cid/ciaa270
    1. Wan S, Xiang Y, Fang W, et al. . Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol 2020;92:797–806. 10.1002/jmv.25783
    1. Liu J, Ouyang L, Guo P. Epidemiological, clinical characteristics and outcome of medical staff infected with COVID-19 in Wuhan, China: a retrospective case series analysis. medRxiv 2020.
    1. Signes-Costa J, Núñez-Gil IJ, Soriano JB, et al. . Prevalence and 30-day mortality in hospitalized patients with Covid-19 and prior lung diseases. Archivos de Bronconeumología 2021;57:13–20. 10.1016/j.arbres.2020.11.012
    1. Nan Y, Xi Z, Yang Y. The 2015 China adult tobacco survey: exposure to second-hand smoke among adults aged 15 and above and their support to policy on banning smoking in public places 2016;37:810–5.
    1. Garufi G, Carbognin L, Orlandi A, et al. . Smoking habit and hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia: The unsolved paradox behind the evidence. Eur J Intern Med 2020;77:121–2. 10.1016/j.ejim.2020.04.042
    1. Wong CK, Lam CWK, Wu AKL, et al. . Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol 2004;136:95–103. 10.1111/j.1365-2249.2004.02415.x
    1. Ruan Q, Yang K, Wang W, et al. . Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46:846–8. 10.1007/s00134-020-05991-x
    1. Chen N, Zhou M, Dong X, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet 2020;395:507–13. 10.1016/S0140-6736(20)30211-7
    1. Qiu F, Liang C-L, Liu H, et al. . Impacts of cigarette smoking on immune responsiveness: up and Down or upside down? Oncotarget 2017;8:268–84. 10.18632/oncotarget.13613
    1. Shiels MS, Katki HA, Freedman ND, et al. . Cigarette smoking and variations in systemic immune and inflammation markers. J Natl Cancer Inst 2014;106. 10.1093/jnci/dju294
    1. Brake SJ, Barnsley K, Lu W, et al. . Smoking upregulates angiotensin-converting enzyme-2 receptor: a potential adhesion site for novel coronavirus SARS-CoV-2 (Covid-19). J Clin Med 2020;9:841. 10.3390/jcm9030841
    1. Hamming I, Timens W, Bulthuis MLC, et al. . Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004;203:631–7. 10.1002/path.1570
    1. Wrapp D, Wang N, Corbett KS, et al. . Cryo-Em structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;367:1260–3. 10.1126/science.abb2507
    1. Wan Y, Shang J, Graham R, et al. . Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol 2020;94. 10.1128/JVI.00127-20
    1. Oakes JM, Fuchs RM, Gardner JD, et al. . Nicotine and the renin-angiotensin system. Am J Physiol Regul Integr Comp Physiol 2018;315:R895–906. 10.1152/ajpregu.00099.2018
    1. Cai G. Tobacco-Use disparity in gene expression of ACE2. the Receptor of 2019-nCov 2020.
    1. Leung JM, Yang CX, Tam A, et al. . ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. Eur Respir J 2020;55. 10.1183/13993003.00688-2020. [Epub ahead of print: 14 May 2020].
    1. Alraddadi BM, Watson JT, Almarashi A, et al. . Risk factors for primary middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia, 2014. Emerg Infect Dis 2016;22:49–55. 10.3201/eid2201.151340
    1. Patanavanich R, Glantz SA. Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine Tob Res 2020;22:1653–6. 10.1093/ntr/ntaa082
    1. Jiménez-Ruiz CA, López-Padilla D, Alonso-Arroyo A. COVID-19 and smoking: a systematic review and meta-analysis of the evidence. Arch Bronconeumol 2021;57:21–34.
    1. Lowe KE, Zein J, Hatipoglu U, et al. . Association of smoking and cumulative Pack-Year exposure with COVID-19 outcomes in the Cleveland clinic COVID-19 registry. JAMA Intern Med 2021;181:709–11. 10.1001/jamainternmed.2020.8360
    1. Vardavas CI, Nikitara K. COVID-19 and smoking: a systematic review of the evidence. Tob Induc Dis 2020;18:20. 10.18332/tid/119324
    1. Adrish M, Chilimuri S, Mantri N, et al. . Association of smoking status with outcomes in hospitalised patients with COVID-19. BMJ Open Respir Res 2020;7:e000716. 10.1136/bmjresp-2020-000716

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren