[COVID-19 and Smoking: A Systematic Review and Meta-Analysis of the Evidence]

Carlos A Jiménez-Ruiz, Daniel López-Padilla, Adolfo Alonso-Arroyo, Rafael Aleixandre-Benavent, Segismundo Solano-Reina, José Ignacio de Granda-Orive, Carlos A Jiménez-Ruiz, Daniel López-Padilla, Adolfo Alonso-Arroyo, Rafael Aleixandre-Benavent, Segismundo Solano-Reina, José Ignacio de Granda-Orive

Abstract

Objective: The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19.

Material and methods: A systematic review (SR) and meta-analysis (MA) of previously published works were performed. The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model.

Results: Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 - 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 - 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress.

Conclusion: Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death.

Keywords: COVID-19; Meta-analysis; Odds ratio; Smoking; Systematic review.

© 2020 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Figura 1
Figura 1
Diagrama de flujo: inclusión de trabajos BECS: Índice Bibliográfico Español en Ciencias de la Salud; LILAC: Literarura Laminoamericana y del Caribe en Ciencias de la Salud; MA: metaanálisis; RS: revisión sistemática.
Figura 2
Figura 2
El tabaquismo actual o previo es un factor de riesgo para una peor evolución de la infección por COVID-19. Forest y funnel plot para los 19 artículos incluidos en el metaanálisis.
Figura 3
Figura 3
El tabaquismo actual o previo es un factor de riesgo para una evolución más crítica (necesidad de intubación orotraqueal, de ingreso en la Unidad de Cuidados Intensivos o muerte) de los pacientes diagnosticados de infección por COVID-19. Forest y funnel plot con los 9 artículos incluidos en el metaanálisis que disponían de los datos de condiciones críticas. IOT: intubación orotraqueal; UCI: unidad de cuidados intensivos.

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