Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study

Monteiro, Ana Carolina Costa; Suri, Rajat; Emeruwa, I.O.; Stretch, Robert; Cortes-Lopez, Roxana Y; Sherman, Alexander E.; Lindsay, Catherine C; Fulcher, Jennifer A.; Goodman‐Meza, David; Sapru, Anil; Buhr, Russell G.; Chang, Steven Y.; Wang, Tisha; Qadir, Nida

doi:10.1371/journal.pone.0238552

Cited by 47 publications

(42 citation statements)

References 36 publications

(43 reference statements)

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“…Seven studies investigated the effect of age on the risk of intubation, using individuals hospitalized due to COVID-19. All studies were set in the USA (42, 55, 74, 82, 88, 91), and a summary of the results can be seen in Table S11. No studies had a low risk of bias (high quality), either due to the “confounding” or “exposure assessment” domain (Table S12).…”

Section: Resultsmentioning

confidence: 99%

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

Starke

Reissig

Petereit-Haack³

et al. 2021

Preprint

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Introduction Increased age has been reported to be a factor for COVID-19 severe outcomes. However, many studies do not consider the age-dependency of comorbidities, which influence the course of disease. Protection strategies often target individuals after a certain age, which may not necessarily be evidence-based. The aim of this review was to quantify the isolated effect of age on hospitalization, admission to ICU, mechanical ventilation, and death. Methods This review was based on an umbrella review, in which Pubmed, Embase, and pre-print databases were searched on December 10, 2020 for relevant reviews on COVID-19 disease severity. Two independent reviewers evaluated the primary studies using predefined inclusion and exclusion criteria. The results were extracted, and each study was assessed for risk of bias. The isolated effect of age was estimated by meta-analysis, and the quality of evidence was assessed using GRADE. Results Seventy studies met our inclusion criteria (case mortality n=14, in-hospital mortality n=44, hospitalization n=16, admission to ICU n=12, mechanical ventilation n=7). The risk of in-hospital and case mortality increased per age year by 5.7% and 7.4%, respectively (Effect Size (ES) in-hospital mortality=1.057, 95% CI:1.038-1.054; ES case mortality= 1.074, 95% CI:1.061-1.087), while the risk of hospitalization increased by 3.4% per age year (ES=1.034, 95% CI:1.021-1.048). No increased risk was observed for ICU admission and intubation by age year. There was no evidence of a specific age threshold at which the risk accelerates considerably. The confidence of evidence was high for mortality and hospitalization. Conclusions Our results show a best-possible quantification of the increase in COVID-19 disease severity due to age. Rather than implementing age thresholds, prevention programs should consider the continuous increase in risk. There is a need for continuous, high-quality research and living reviews to evaluate the evidence throughout the pandemic, as results may change due to varying circumstances.

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Section: Resultsmentioning

confidence: 99%

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

Starke

Reissig

Petereit-Haack³

et al. 2021

Preprint

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“…Epidemiological studies continue to fuel conflicting results. While most of the studies to date have indicated an association between smoking and increased viral infection susceptibility and worsening of COVID-19 symptoms [24,[32][33][34][35][36][37][38][39][40][41][42][43][44][45], also highlighting the importance of the cumulative pack-year exposure [41], there are several studies that have observed an inverse relationship between smoking and COVID-19 [44,[46][47][48][49][50][51]. In particular, smoking prevalence among patients hospitalized with COVID-19 has been reported to be lower than the smoking prevalence in the general population [46,47,52] and these data were also confirmed in 132 patients who were admitted to our university hospital [53].…”

Section: Discussionmentioning

confidence: 99%

Lower Gene Expression of Angiotensin Converting Enzyme 2 Receptor in Lung Tissues of Smokers with COVID-19 Pneumonia

et al. 2021

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Angiotensin-converting enzyme 2 (ACE-2) is the main cell entry receptor for severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), thus playing a critical role in causing Coronavirus disease 2019 (COVID-19). The role of smoking habit in the susceptibility to infection is still controversial. In this study we correlated lung ACE-2 gene expression with several clinical/pathological data to explore susceptibility to infection. This is a retrospective observational study on 29 consecutive COVID-19 autopsies. SARS-CoV-2 genome and ACE-2 mRNA expression were evaluated by real-time polymerase chain reaction in lung tissue samples and correlated with several data with focus on smoking habit. Smoking was less frequent in high than low ACE-2 expressors (p = 0.014). A Bayesian regression also including age, gender, hypertension, and virus quantity confirmed that smoking was the most probable risk factor associated with low ACE-2 expression in the model. A direct relation was found between viral quantity and ACE-2 expression (p = 0.028). Finally, high ACE-2 expressors more frequently showed a prevalent pattern of vascular injury than low expressors (p = 0.049). In conclusion, ACE-2 levels were decreased in the lung tissue of smokers with severe COVID-19 pneumonia. These results point out complex biological interactions between SARS-CoV-2 and ACE-2 particularly concerning the aspect of smoking habit and need larger prospective case series and translational studies.

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“…Data interpretation: Our three important findings are not independent of each other. Obesity is a recognized risk factor for COVID-19 infection and is associated with poor survival, particularly among patients treated in intensive care units and those requiring mechanical ventilation [13,14]. Obesity is known to be associated with a compromised immune system [15], in addition to the significant buildup of internal body fat, which has its mechanical effect in compromising normal physiological respiration including diaphragmatic and lung function [16,17].…”

Section: Discussionmentioning

confidence: 99%

Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy

Henein

Bytyçi

Nicoll

et al. 2021

JCM

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Background and Aims: The Coptic clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and to identify predictors of clinical adverse events. Methods: Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt, and Group III: Southern Egypt. Participants’ demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management, and major adverse events (MAEs), comprising death, or mechanical ventilation, were assessed. Results: Out of the 1570 clergy serving in 25 dioceses, 255 (16.2%) were infected. Their mean age was 49.5 ± 12 years and mean weekly number of liturgies was 3.44 ± 1.0. The overall prevalence rate was 16.2% and did not differ between Egypt as a whole and overseas (p = 0.23). Disease prevalence was higher in Northern Egypt clergy compared with Europe and USA combined (18.4% vs. 12.1%, p = 0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p = 0.09). Ten priests (3.92%) died of COVID-19-related complications, and 26 (10.2) suffered a MAE. The clergy from Southern Egypt were more obese, but the remaining risk factors were less prevalent compared with those in Europe and USA (p = 0.01). In multivariate analysis, obesity (OR = 4.180; 2.479 to 12.15; p = 0.01), age (OR = 1.055; 0.024 to 1.141; p = 0.02), and systemic hypertension (OR = 1.931; 1.169 to 2.004; p = 0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p < 0.05 for both). Conclusion: Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. Coptic clergy should be encouraged to follow the WHO recommendations for cardiovascular disease and COVID-19 prevention.

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Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study

Cited by 47 publications

References 36 publications

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

Lower Gene Expression of Angiotensin Converting Enzyme 2 Receptor in Lung Tissues of Smokers with COVID-19 Pneumonia

Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy

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