The effect of smoking on COVID‐19 severity: A systematic review and meta‐analysis

Reddy, Rohin K; Charles, Walton N; Sklavounos, Alexandros; Dutt, Atul; Seed, Paul; Khajuria, Ankur

doi:10.1002/jmv.26389

Cited by 348 publications

(341 citation statements)

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“…Together with DM, all these risk factors contribute to the exacerbation of preexisting chronic inflammation, progressing to cytokine storm and rapid impairment of endothelial function, if left untreated [28]. The low prevalence of smoking in the study (2.6%) is in alignment with several retrospective observational studies that highlight the unexpectedly low prevalence of smokers among hospitalized patients with Covid-19, but with worse outcomes [29,30]. Other significant factors for poor outcomes identified in the present study are the use of β-blockers and severe vitamin D deficiency among admitted Covid-19 patients.…”

Section: Established Predictors and Potential Factors Influencing Covsupporting

confidence: 60%

Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study

Alguwaihes

Al-Sofiani

Megdad

et al. 2020

Cardiovasc Diabetol

131

133

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Background Information on the clinical characteristics and outcomes of hospitalized Covid-19 patients with or without diabetes mellitus (DM) is limited in the Arab region. This study aims to fill this gap. Methods In this single-center retrospective study, medical records of hospitalized adults with confirmed Covid-19 [RT-PCR positive for SARS-CoV2] at King Saud University Medical City (KSUMC)-King Khaled University Hospital (KKUH), Riyadh, Saudi Arabia from May to July 2020 were analyzed. Clinical, radiological and serological information, as well as outcomes were recorded and analyzed. Results A total of 439 patients were included (median age 55 years; 68.3% men). The most prevalent comorbidities were vitamin D deficiency (74.7%), DM (68.3%), hypertension (42.6%) and obesity (42.2%). During hospitalization, 77 out of the 439 patients (17.5%) died. DM patients have a significantly higher death rate (20.5% versus 12.3%; p = 0.04) and lower survival time (p = 0.016) than non-DM. Multivariate cox proportional hazards regression model revealed that age [Hazards ratio, HR 3.0 (95% confidence interval, CI 1.7–5.3); p < 0.001], congestive heart failure [adjusted HR 3.5 (CI 1.4–8.3); p = 0.006], smoking [adjusted HR 5.8 (CI 2.0–17.2); p < 0.001], β-blocker use [adjusted HR 1.7 (CI 1.0–2.9); p = 0.04], bilateral lung infiltrates [adjusted HR 1.9 (CI 1.1–3.3); p = 0.02], creatinine > 90 µmol/l [adjusted HR 2.1 (CI 1.3–3.5); p = 0.004] and 25(OH)D < 12.5 nmol/l [adjusted HR 7.0 (CI 1.7–28.2); p = 0.007] were significant predictors of mortality among hospitalized Covid-19 patients. Random blood glucose ≥ 11.1 mmol/l was significantly associated with intensive care admission [adjusted HR 1.5 (CI 1.0–2.2); p = 0.04], as well as smoking, β-blocker use, neutrophil > 7.5, creatinine > 90 µmol/l and alanine aminotransferase > 65U/l. Conclusion The prevalence of DM is high among hospitalized Covid-19 patients in Riyadh, Saudi Arabia. While DM patients have a higher mortality rate than their non-DM counterparts, other factors such as old age, congestive heart failure, smoking, β-blocker use, presence of bilateral lung infiltrates, elevated creatinine and severe vitamin D deficiency, appear to be more significant predictors of fatal outcome. Patients with acute metabolic dysfunctions, including hyperglycemia on admission are more likely to receive intensive care.

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Section: Established Predictors and Potential Factors Influencing Covsupporting

confidence: 60%

Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study

Alguwaihes

Al-Sofiani

Megdad

et al. 2020

Cardiovasc Diabetol

131

133

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“…However, as the authors rightly state, this multivariable-adjusted HR cannot capture any causal effect of smoking due to adjustments for conditions that may mediate a smoking effect. (2) Quality, not just quantity Commendably, the meta-analysis in question did perform a valuable sensitivity analysis showing that when only analyzing goodquality studies, the effects of smoking became nonsignificant 3. Ignoring the debate around the "value of the p-value," 8 this demonstrates the importance of sensitivity analysis, rigorous appraisal of study quality, underlines the concept of "research waste,"1 and probably really suggests that the best available evidence in hospitalized patients shows a noncommittal result.…”

mentioning

confidence: 99%

Deriving “definitive” results in observational COVID‐19 research: A problematic endeavor

Clift

2020

Journal of Medical Virology

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“…Among hospitalized patients, the risk of developing severe COVID-19 (as measured by admission to the intensive care unit and/or in-hospital death) is consistently higher among smokers. The largest meta-analysis to date included 47 studies with a total of 32,849 hospitalized COVID-19 patients (Reddy et al 2020) and confirmed that current smokers had an increased risk of severe COVID-19 (risk ratio [RR]: 1.80; 95% confidence interval [CI]: 1.14-2.85; p = 0.012) and severe or critical COVID-19 (RR: 1.98; CI: 1.16-3.38; p = 0.012). A history of smoking was associated with severe COVID-19 (RR: 1.31; CI: 1.12-1.54; p = 0.001), severe or critical COVID-19 (RR: 1.35; CI: 1.19-1.53; p < 0.0001), in-hospital mortality (RR: 1.26; CI: 1.20-1.32; p < 0.0001), progression of COVID-19 (RR: 2.18; CI: 1.06-4.49; p = 0.035), and need for mechanical ventilation (RR: 1.20; CI: 1.01-1.42; p = 0.043).…”

Section: Smoking Is a Prognostic Factor For Covid-19mentioning

confidence: 99%

Tobacco and COVID-19: a crisis within a crisis?

Alla

Berlin

Nguyen-Thanh

et al. 2020

Can J Public Health

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During the pandemic, the world's media have publicized preliminary findings suggesting that tobacco use is protective against COVID-19. An ad hoc multidisciplinary group was created to address the major public health implications of this messaging. Key messages of this commentary are as follows: 1) The COVID-19 crisis may increase tobacco consumption and decrease access to healthcare. As a result, smoking-related morbidity and mortality could increase in the coming months and years; 2) Smoking and tobacco-related diseases are prognostic factors for severe COVID-19; and 3) In theory, smokers may be at lower risk of COVID-19 infection because of having fewer social contacts. In conclusion, tobacco control is a greater challenge than ever in the context of the COVID-19 pandemic. Public decision-makers must be vigilant in ensuring that public health practices are consistent and compliant with the principles of the WHO Framework Convention on Tobacco Control. In addition, researchers and the media have a responsibility to be cautious in communicating preliminary results that may promote nonevidence-based research, self-destructive individual behaviours, and commercial agendas. Résumé Pendant la pandémie, des résultats préliminaires sur l'effet protecteur du tabac sur la COVID-19 ont été largement diffusés dans le monde entier. Dans ce contexte, et en raison des questions de santé publique liées à ce sujet, un groupe multidisciplinaire ad hoc a été créé en réponse aux demandes des institutions de santé publique. Les messages clés de ce commentaire sont les suivants : 1) La crise de la COVID-19 pourrait entraîner une augmentation de la consommation de tabac et une diminution de l'accès aux soins. En conséquence, la morbidité et la mortalité liées au tabagisme pourraient augmenter dans les mois et les années à venir; 2) Le tabagisme et les maladies liées au tabac sont des facteurs pronostiques de formes graves de la COVID-19; et 3) Hypothétiquement, les fumeurs, notamment en réduisant la fréquence et la durée des contacts sociaux, pourraient être moins susceptibles d'être contaminés. En conclusion, même pendant et malgré la crise sanitaire due à la pandémie de la COVID-19, la lutte contre le tabagisme reste plus que jamais un défi. Les décideurs publics doivent être particulièrement vigilants pour assurer la cohérence des pratiques publiques, y compris le respect des principes de la Convention-cadre de l'OMS pour la lutte antitabac. Il incombe également aux chercheurs et aux médias de communiquer avec prudence des résultats préliminaires susceptibles de générer des comportements individuels contre-productifs et d'être instrumentalisés à des fins commerciales.

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The effect of smoking on COVID‐19 severity: A systematic review and meta‐analysis

Cited by 348 publications

References 100 publications

Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study

Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study

Deriving “definitive” results in observational COVID‐19 research: A problematic endeavor

Tobacco and COVID-19: a crisis within a crisis?

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