https://doi.org/10.4081/monaldi.2025.2916
Smoking patterns and outcomes of severe sars-CoV-2 infection: a retrospective cohort study
Submitted: January 17, 2024
Accepted: November 11, 2024
Published: January 17, 2025
Accepted: November 11, 2024
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PDF_EARLY VIEW: 74
SUPPLEMENTARY MATERIAL: 15
SUPPLEMENTARY MATERIAL: 15
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The purpose of this study was to analyze the association between the number of cigarettes smoked and the length of smoking with mortality among patients who were hospitalized in the intensive care unit (ICU) due to SARS-CoV-2 infection. This retrospective cohort study was conducted at the General Hospital in Sombor (Serbia). Patients who were hospitalized because of severe SARS-CoV-2 infection between March 2021 and March 2023 were included in this study. Data were retrieved from electronic medical records, including those on smoking status, duration of smoking, and the number of cigarettes smoked per day. Of 307 patients whose medical records were analyzed, 40.7% were current smokers. Current smokers more often required treatment in the ICU, where they also had a higher mortality rate compared to current non-smokers. Longer duration of smoking was independently associated with dying of SARS-CoV-2 infection in the ICU. The Kaplan-Meier survival curve showed that hospitalized patients with SARS-CoV-2 infection who smoked had poorer survival compared to current non-smokers. According to the receiver operating characteristic curve, patients who smoked for more than 40 years had a 73.9% chance of dying from SARS-CoV-2 infection. Current smokers who smoked 22.5 cigarettes per day had a 75.4% chance of dying from SARS-CoV-2 infection in the ICU. Smokers with severe SARS-CoV-2 infection had a higher likelihood of having poor outcomes. Longer duration of smoking was an independent predictor of SARS-CoV-2 mortality. Smoking prevention and smoking cessation are of paramount importance in the prevention of SARS-CoV-2-related mortality.
Vardavas CI, Nikitara K. COVID-19 and smoking: a systematic review of the evidence. Tob Induc Dis 2020;18:20.
DOI: https://doi.org/10.18332/tid/119324
Jacobs M, Van Eeckhoutte H P, Wijnant SR, et al. Increased expression of ACE2, the SARS-CoV-2 entry receptor, in alveolar and bronchial epithelium of smokers and COPD subjects. Eur Resp J 2020;56:2002378.
DOI: https://doi.org/10.1183/13993003.02378-2020
Edmiston JB, Cohn EG, Teruya SL, et al. Clinical and social determinants of health features of SARS-CoV-2 infection among Black and Caribbean Hispanic patients with heart failure: the SCAN-MP Study. PLoS One 2023;18:e0283730.
DOI: https://doi.org/10.1371/journal.pone.0283730
Oakes JM, Fuchs RM, Gardner JD, et al. Nicotine and the renin-angiotensin system. Am J Physiol Regul Integr Comp Physiol 2018;315:895-906.
DOI: https://doi.org/10.1152/ajpregu.00099.2018
Miyara M, Tubach F, Pourcher V, et al. Lower rate of daily smokers with symptomatic COVID-19: a monocentric self-report of smoking habit study. Front Med 2022;8:668995.
DOI: https://doi.org/10.3389/fmed.2021.668995
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;55:2000688.
DOI: https://doi.org/10.1183/13993003.00688-2020
Gao M, Aveyard P, Lindson N, et al. Association between smoking, e-cigarette use and severe COVID-19: a cohort study. Int J Epidemiol 2022;51:1062-72.
DOI: https://doi.org/10.1093/ije/dyac028
Patanavanich R, Siripoon T, Amponnavarat S, Glantz SA. active smokers are at higher risk of COVID-19 death: a systematic review and meta-analysis. Nicotine Tob Res 2023;25:177-84.
DOI: https://doi.org/10.1093/ntr/ntac085
Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis. BMC Public Health 2021;21:1554.
DOI: https://doi.org/10.1186/s12889-021-11579-x
Serbian Medical Chamber. Therapeutic protocol for COVID-19. Available from: https://www.lks.org.rs/images/Documents/Obavestenja/Protokol%20za%20le%C4%8Denje%20pacijenata%20sa%20%20COVID%2019%20%D0%B0%D0%BF%D1%80%D0%B8%D0%BB%2021.pdf. Accessed on: 31/10/2023. [Material in Serbian].
Menachemi N, Dixon BE, Wools-Kaloustian KK, et al. How many SARS-CoV-2-infected people require hospitalization? Using random sample testing to better inform preparedness efforts. J Public Health Manag Pract 2021;27:246-50.
DOI: https://doi.org/10.1097/PHH.0000000000001331
Mohsin FM, Tonmon TT, Nahrin R, et al. Association Between Smoking and COVID-19 Severity: Evidence from Bangladesh. J Multidiscip Healthc 2021;14:1923-33.
DOI: https://doi.org/10.2147/JMDH.S317603
Le Guen CL, Muir KC, Simons M, et al. The impact of smoking status and smoking-related comorbidities on coronavirus disease 2019 patient outcomes: a causal mediation analysis. Nicotine Tob Res 2023;25:331-8.
DOI: https://doi.org/10.1093/ntr/ntac193
WHO. WHO report on the global tobacco epidemic 2021. Country profile. Serbia. Available from: https://cdn.who.int/media/docs/default-source/country-profiles/tobacco/who_rgte_2021_serbia.pdf?sfvrsn=50e60c0a_5&download=true.
Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.
DOI: https://doi.org/10.1183/13993003.01227-2020
Grzywa-Celińska A, Krusiński A, Milanowski J. 'Smoging kills' - Effects of air pollution on human respiratory system. Ann Agric Environ Med 2020;27:1-5.
DOI: https://doi.org/10.26444/aaem/110477
Ganesan S, Comstock AT, Sajjan US. Barrier function of airway tract epithelium. Tissue Barriers 2013;1:e24997.
DOI: https://doi.org/10.4161/tisb.24997
Wistuba II, Gazdar AF. Lung cancer preneoplasia. Annu Rev Pathol 2006;1:331-48.
DOI: https://doi.org/10.1146/annurev.pathol.1.110304.100103
Samara K, Zervou M, Siafakas NM, Tzortzaki EG. Microsatellite DNA instability in benign lung diseases. Respir Med 2006;100:202-11.
DOI: https://doi.org/10.1016/j.rmed.2005.05.015
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.
DOI: https://doi.org/10.1016/j.ejim.2020.03.014
Patanavanich R, Glantz SA. Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine Tob Res 2020;22:1653-6.
DOI: https://doi.org/10.1093/ntr/ntaa082
Rohleder N, Kirschbaum C. The hypothalamic-pituitary-adrenal (HPA) axis in habitual smokers. Int J Psychophysiol 2006;59:236-43.
DOI: https://doi.org/10.1016/j.ijpsycho.2005.10.012
Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: a narrative review. Tob Induc Dis 2020;18:60.
DOI: https://doi.org/10.18332/tid/123845
Almirall J, Serra-Prat M, Bolibar I, Balasso V. Risk factors for community-acquired pneumonia in adults: a systematic review of observational studies. Respiration 2017;94:299-311.
DOI: https://doi.org/10.1159/000479089
Nuorti JP, Butler JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med 2000;342:681-9.
DOI: https://doi.org/10.1056/NEJM200003093421002
Almirall J, Bolibar I, Serra-Prat M, et al. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J 2008;31:1274-84.
DOI: https://doi.org/10.1183/09031936.00095807
Kihara T, Yamagishi K, Iso H, Tamakoshi A. The association of smoking cessation with mortality from pneumonia among middle-aged and elderly community residents: the Japan Collaborative Cohort (JACC) study. Prev Med 2022;163:107188.
DOI: https://doi.org/10.1016/j.ypmed.2022.107188
Xu L, Chen B, Wang F, et al. A higher rate of pulmonary fungal infection in chronic obstructive pulmonary disease patients with influenza in a large tertiary hospital. Respiration 2019;98:391-400.
DOI: https://doi.org/10.1159/000501410
Musellim B, Erturan S, Sonmez Duman E, Ongen G. Comparison of extra-pulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation. Int J Tuberc Lung Dis 2005;9:1220-3.
Ahrenfeldt LJ, Otavova M, Christensen K, Lindahl-Jacobsen R. Sex and age differences in COVID-19 mortality in Europe. Wien Klin Wochenschr 2021;133:393-8.
DOI: https://doi.org/10.1007/s00508-020-01793-9
Aleksanyan Y, Weinman JP. Women, men and COVID-19. Soc Sci Med 2022;294:114698.
DOI: https://doi.org/10.1016/j.socscimed.2022.114698
Marinković I, Tramošljanin A. Mortality in Serbia due to the COVID-19 pandemic: Overview of basic mortality data for 2020 and 2021. Stanovnistvo 2022;60:165-9.
DOI: https://doi.org/10.59954/stnv.501
Ethics Approval
This study was approved by the Ethics Committee of the General Hospital "Dr Radivoj Simonovic" Sombor (approval no. 23-2171-2023-2).How to Cite
Beronja, Branko, Aleksandra Karan, Biljana Lukic, Ivana Milosevic, Jelena Dotlic, and Tatjana Gazibara. 2025. “Smoking Patterns and Outcomes of Severe Sars-CoV-2 Infection: A Retrospective Cohort Study”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2025.2916.
Copyright (c) 2025 The Author(s)
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