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. 2022 Sep 9;159(5):214-223.
doi: 10.1016/j.medcle.2022.07.010. Epub 2022 Aug 1.

Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: Results from the SEMI-COVID-19 registry

María Sierra Navas Alcántara  1 , Lorena Montero Rivas  1 , María Esther Guisado Espartero  1 , Manuel Rubio-Rivas  2 , Blanca Ayuso García  3 , Francisco Moreno Martinez  4 , Cristina Ausín García  5 , María Luisa Taboada Martínez  6 , Francisco Arnalich Fernández  7 , Raúl Martínez Murgui  8 , Sonia Molinos Castro  9 , Maria Esther Ramos Muñoz  10 , Mar Fernández-Garcés  11 , Mari Cruz Carreño Hernandez  12 , Gema María García García  13 , Nuria Vázquez Piqueras  14 , Jesica Abadía-Otero  15 , Lourdes Lajara Villar  16 , Cristina Salazar Monteiro  17 , María de Los Reyes Pascual Pérez  18 , Santiago Perez-Martin  19 , Javier Collado-Aliaga  20 , Juan-Miguel Antón-Santos  21 , Carlos Lumbreras-Bermejo  3 ; SEMI-COVID19 group
Affiliations

Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: Results from the SEMI-COVID-19 registry

María Sierra Navas Alcántara et al. Med Clin (Engl Ed). .

Abstract
in English, Spanish

Introduction: Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the coronavirus disease (COVID-19).

Methods: Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analysed. A multivariate logistic regression and Kapplan Meier curves analysed the relationship between smoking and in-hospital mortality.

Results: The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 (59.6-78.0 years)), more frequently male (80.3%) and with higher Charlson index (4 (2-6)) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs. 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events.

Conclusions: Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.

Introducción: El tabaquismo puede tener un papel importante en la infección por SARS-CoV-2 y en el curso de la enfermedad. Los estudios previos muestran resultados contradictorios o no concluyentes sobre la prevalencia de fumar y la severidad en la enfermedad por coronavirus (COVID-19).

Material y métodos: Estudio de cohortes observacional, multicéntrico y retrospectivo de 14.260 pacientes que ingresaron por COVID-19 en hospitales españoles desde febrero a septiembre de 2020. Se registraron sus características clínicas y se clasificaron en el grupo con tabaquismo si tabaquismo activo o previo o en el grupo sin tabaquismo si nunca habían fumado. Se realizó un seguimiento hasta un mes después del alta. Se analizaron las diferencias entre grupos. La relación entre tabaquismo y mortalidad intrahospitalaria se valoró mediante una regresión logística multivariante y curvas de Kapplan Meier.

Resultados: La mediana de edad fue 68,6 (55,8–79,1) años, con un 57,7% de varones. El grupo con tabaquismo presentó mayor edad (69,9 (59,6–78,0 años)), predominio masculino (80,3%) y mayor índice de Charlson (4 (2−6)). La evolución fue peor en estos pacientes, con una mayor tasa de ingreso en UCI (10,4 vs 8,1%), mayor mortalidad intrahospitalaria (22,5 vs 16,4%) y reingreso al mes (5,8 vs 4,0%) que el grupo sin tabaquismo. Tras el análisis multivariante, el tabaquismo permanecía asociado a estos eventos.

Conclusiones: El tabaquismo de forma activa o pasada es un factor predictor independiente de mal pronóstico en los pacientes con COVID-19, estando asociada a mayor probabilidad de ingreso en UCI y a mayor mortalidad intrahospitalaria.

Keywords: COVID-19; Hospitalised; Mortality; SARS-CoV-2; Smoking.

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Figures

Figure 1
Figure 1
Flowchart of patient inclusion.
Figure 2
Figure 2
Kapplan Meier curves for patient in-hospital mortality according to smoking.
See this image and copyright information in PMC

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