Department of Medicine, Bronx Care Health System, Bronx, New York, USA
Department of Medicine, Bronx Care Health System, Bronx, New York, USA.
BMJ Open Respir Res. 2020 Oct;7(1). doi: 10.1136/bmjresp-2020-000716.
Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association.
This was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020.
1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival.
In our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death.
吸烟通过释放细胞因子和损害黏液纤毛清除功能引起肺上皮炎症。一些研究将吸烟与 COVID-19 患者的疾病严重程度联系起来，而另一些研究则没有发现这种关联。
这是一项对 2020 年 3 月 9 日至 5 月 18 日期间所有因 COVID-19 住院的成年人进行的回顾性分析。
符合研究标准的患者共 1173 例。837 例患者从不吸烟，336 例患者为现吸烟者或既往吸烟者，归入吸烟者组。吸烟者组患者更可能为男性，且更常患有慢性阻塞性肺疾病（19%比 6%，p<0.001）、HIV 感染（11%比 5%，p<0.001）、癌症（11%比 6%，p=0.005）、充血性心力衰竭（15%比 8%，p<0.001）、冠状动脉疾病（15%比 9%，p=0.3）、慢性肾脏病（11%比 8%，p=0.037）和终末期肾病（10%比 6%，p=0.009）。预后分析显示，吸烟者更易发展为需要机械通气的重症疾病（47%比 37%，p=0.005）。根据吸烟状况进行生存分析的单变量 Cox 模型显示，仅吸烟者与从不吸烟者相比，死亡风险更高（HR 1.61，95%CI 1.22-2.12，p<0.001）。在多变量方法中，用于生存的 Cox 模型、女性、年龄较小、低血清乳酸脱氢酶和全身皮质类固醇使用与总体生存改善相关。
在我们对 COVID-19 住院患者的大型单中心回顾性数据库中，吸烟与重症疾病的发生和死亡风险增加相关。
