Djuric Marko, Nenadic Irina, Radisavljevic Nina, Todorovic Dusan, Dimic Nemanja, Bobos Marina, Bojic Suzana, Savic Predrag, Turnic Tamara Nikolic, Stevanovic Predrag, Djukic Vladimir
Clinic for Anesthesiology and Intensive Care, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", No. 1, Str. Heroja Milana Tepica, 11030 Belgrade, Serbia.
Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Healthcare (Basel). 2025 May 1;13(9):1041. doi: 10.3390/healthcare13091041.
The COVID-19 pandemic revealed an unexpected pattern known as the "smoker's paradox", with lower rates of severe disease among smokers compared to non-smokers, highlighting the need for the specific investigation of disease progression in non-smoking populations. Objective: To identify early mortality predictors in non-smoking patients with severe COVID-19 through the evaluation of clinical, laboratory, and oxygenation parameters. This retrospective observational cohort study included 59 non-smokers hospitalized with COVID-19 between November and December 2020. Clinical parameters, laboratory findings, and respiratory support requirements were analyzed on Days 1 and 7 of hospitalization. ROC curves were constructed to assess the predictive value of the parameters. The overall mortality rate was 54.2%. The seventh-day SOFA score showed the strongest predictive value (AUC = 0.902, = 0.004), followed by pCO (AUC = 0.853, = 0.012). Significant differences between survivors and non-survivors were observed in acid-base parameters, oxygenation indices, and hematological markers. Mortality rates varied significantly with ventilation type: 84.6% for IMV and 50% for NIMV, with no deaths in HFNC patients. Multiple parameters measured on Day 7 of hospitalization demonstrate significant predictive value for mortality in non-smoking COVID-19 patients, with the SOFA score being the strongest predictor. The type of respiratory support significantly influences outcomes, suggesting the importance of careful ventilation strategy selection.
新冠疫情揭示了一种意想不到的模式，即所谓的“吸烟者悖论”，吸烟者中重症疾病的发生率低于非吸烟者，这凸显了对非吸烟人群疾病进展进行专项调查的必要性。目的：通过评估临床、实验室和氧合参数，确定重度新冠肺炎非吸烟患者的早期死亡预测因素。这项回顾性观察队列研究纳入了2020年11月至12月期间因新冠肺炎住院的59名非吸烟者。在住院第1天和第7天分析临床参数、实验室检查结果和呼吸支持需求。构建ROC曲线以评估这些参数的预测价值。总死亡率为54.2%。第7天的序贯器官衰竭评估（SOFA）评分显示出最强的预测价值（曲线下面积[AUC]=0.902，P=0.004），其次是动脉血二氧化碳分压（pCO₂）（AUC=0.853，P=0.012）。在酸碱参数、氧合指数和血液学指标方面，幸存者和非幸存者之间存在显著差异。死亡率因通气类型而异：有创机械通气（IMV）患者为84.6%，无创机械通气（NIMV）患者为50%，高流量鼻导管吸氧（HFNC）患者无死亡病例。住院第7天测量的多个参数对重度新冠肺炎非吸烟患者的死亡率具有显著预测价值，其中SOFA评分是最强的预测指标。呼吸支持类型对预后有显著影响，提示谨慎选择通气策略的重要性。
