Smoking and risk of COVID-19 hospitalization

Evolution of COVID-19 infection characteristics in a Lebanese cohort of inpatients during different pandemic periods

This study aims to describe COVID-19 patients characteristics, laboratory and imaging results, and the different outcomes of patients admitted to the Lebanese American University Medical Center-Rizk Hospital over a period of 9 months. In this observational retrospective study, data were obtained from electronic medical records of 491 male and female patients from the ages of 17 to 97. Analysis of the patients was performed in 3 periods: August 2020 to October 20 November 202020 to January 2021 and February 2021 to April 2021 corresponding with 3 waves of newly diagnosed cases during this period. The sample showed a male predominance with an average age of 63. The average hospitalization length was 10.1 days. The majority of patients were discharged to quarantine. The distribution of hospitalized cases was significantly correlated to the monthly distribution of newly COVID-19 cases in Lebanon. There was no significant difference in patient's characteristics between the 3 periods of the study (gender, age, body mass index, smoking, and medical conditions). Clinical presentations of the patients varied between the 3 periods. Similarly, the course and outcome of infection varied. Patients received less oxygen during period 1, while more patients were cured during period 3. This study presents the first Lebanese cohort of COVID-19 patients with their medical background, clinical presentation, laboratory results, radiological findings and course of infection with its outcome. It also shows how the relations between the medical manifestation of the COVID-19 pandemic and the socio-political measures of infection control are deeply intertwined.

Exploring the Relationship of Comorbidities, Smoking Status, HRCT Findings With COVID-19 Disease Severity and Outcomes

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is a serious illness that can affect multiple organs including the lungs. The COVID-mortality risk is attributed to the quick transmission of the virus, the severity of disease, and preclinical risk factors, such as the presence of comorbidities. High-resolution computed tomography (HRCT) can predict disease severity in COVID-19 patients.

METHODOLOGY

This was a retrospective cohort study in which data were obtained from COVID centers at tertiary care hospitals in Azad Jammu and Kashmir. Details of clinical characteristics and HRCT findings along with details of smoking and comorbid history were obtained.

RESULTS

Fever at hospital admission, HRCT findings, and having a partner predicted disease severity showed a significant p-value of <0.05. Old age and living in a combined household were associated with severe outcomes (p<0.05). Symptoms of shortness of breath (SOB) on hospital admission could predict the need for ICU admission in COVID-19 patients.

CONCLUSION

HRCT has a good predictive value for disease severity in patients with COVID-19, and old age is a risk factor. Although, limited associations were established in the analysis, in this study hyperlipidemia and hypertension significantly affected the course of disease. Further studies should be done to explore the relationship.

Recovery from Respiratory Failure in Patients with Coronavirus Disease 2019

OBJECTIVE

Coronavirus disease 2019 (COVID-19) can cause hypoxic respiratory failure; long-term oxygen therapy (LTOT) duration is unknown.

MATERIAL AND METHODS

The aim was to investigate which patients would need LTOT after COVID-19 pneumonia. This single-center, prospective study was conducted at the Ankara University Faculty of Medicine, Department of Chest Diseases, between May 2021 and December 2021. The 70 patients hospitalized for COVID-19 pneumonia and discharged with LTOT due to hypoxemic respiratory failure were included. Patients were divided into 2 groups as group I (LTOT requirement <3 months) and group II (LTOT requirement continued ≥3 months).

RESULTS

The mean age was 64.4 ± 13.5 years, and 44 (62.9%) of them were male. The most frequently encountered comorbidities were cardiovascular disease (57.1%) and lung disease (22.9%). While PaO2 levels increased in both groups during the follow-up period, this increment was significantly higher in group I (PaO2: 66.6 ± 9.9 mm Hg, P < .001). The factors affecting the LTOT requirement were evaluated using binary logistic regression. On multivariate analyses of lymphocytes, ferritin, C-reactive protein, PaO2, SaO2, subpleural reticulation, and number of lobes affected (≥3 lobes), the SaO2 level and presence of subpleural reticulation were significantly different between the 2 groups [odds ratio (OR) (95% CI): 0.853 (0.749-0.971), P = .016] and [OR (95% CI): 0.171 (0.042-0.733), P = .017], respectively.

CONCLUSION

A significant proportion of patients who develop respiratory failure due to COVID-19 recover within the first 3 months. Factors determining the LTOT requirement for more than 3 months were SaO2 and the presence of subpleural reticulation.

Live to die another day: novel insights may explain the pathophysiology behind smoker's paradox in SARS-CoV-2 infection

The severe acute respiratory coronavirus 2 (SARS-CoV-2) infection demonstrates a highly variable and unpredictable course. Several reports have claimed a smoker's paradox in coronavirus disease 2019 (COVID-19), in line with previous suggestions that smoking is associated with better survival after acute myocardial infarction and appears protective in preeclampsia. Several plausible physiological explanations exist accounting for the paradoxical observation of smoking engendering protection against SARS-CoV-2 infection. In this review, we delineate novel mechanisms whereby smoking habits and smokers' genetic polymorphism status affecting various nitric oxide (NO) pathways (endothelial NO synthase, cytochrome P450 (CYP450), erythropoietin receptor (EPOR); β-common receptor (βcR)), along with tobacco smoke modulation of microRNA-155 and aryl-hydrocarbon receptor (AHR) effects, may be important determinators of SARS-CoV-2 infection and COVID-19 course. While transient NO bioavailability increase and beneficial immunoregulatory modulations through the above-mentioned pathways using exogenous, endogenous, genetic and/or therapeutic modalities may have direct and specific, viricidal SARS-CoV-2 effects, employing tobacco smoke inhalation to achieve protection equals self-harm. Tobacco smoking remains the leading cause of death, illness, and impoverishment.

The predisposition of smokers to COVID-19 infection: A mini-review of global perspectives

Both SARS-CoV-2 and smoking tobacco adversely impact the respiratory system, damaging the airways and impairing lung function. While some studies have identified a positive association between smoking and increased susceptibility to COVID-19 infections, a few papers have concluded that smokers may be protected against such infections. Given these contradictory findings, there is an ongoing debate in the scientific community about whether or not smokers have a stronger predisposition towards COVID-19 infections. Through this mini-review, we aimed to study the relationship between tobacco smoking and COVID-19 infections by conducting a comprehensive literature search of peer reviewed articles that reported on the effects of smoking on COVID-19 susceptibility and were published globally over the past two years (January 2020-April 2022). Our search identified 31 articles that demonstrated a positive or strong relationship between smoking and COVID-19, while 13 articles had contrasting results. Additionally, we evaluated mechanistic studies suggesting that, among smokers, angiotensin-converting enzyme-2 genes are upregulated, facilitating easier binding of SARS-CoV-2, thereby increasing the risk of COVID-19 infection. In conclusion, the majority of studies in this area to date provide evidence of a strong relationship between smoking and COVID-19 infection; however, the strength of this association may vary across the smoking behaviors of differing populations. Future work could involve a meta-analysis of studies focusing on susceptibility to COVID-19 infection for different types of tobacco product smokers, which would result in a more comprehensive understanding of the predisposition of smokers towards COVID-19 infections.

Sex, Age, and Comorbidities Are Associated with SARS-CoV-2 Infection, COVID-19 Severity, and Fatal Outcome in a Mexican Population: A Retrospective Multi-Hospital Study

People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological COVID-19 data were collected from 65 hospitals from December 2020 to May 2022. A total of 75,232 cases were compiled from which 25,722 cases were positive for SARS-CoV-2. Male sex, older age, diabetes, obesity, and hypertension were associated with infection. In addition to the above-mentioned factors, renal disease, cardiovascular disease, and immunosuppression were found to be associated with increased COVID-19 severity. These factors, as well as neurological diseases, are also associated with death due to COVID-19. When comparing the different variants of SARs-CoV-2, the variant B1.1.519 increased the probability of death by 2.23 times compared to the AY.20 variant. Male sex, older age, diabetes, obesity, and hypertension are associated with SARS-CoV-2 infection, severity, and death. Along with the aforementioned comorbidities, renal disease, cardiovascular disease, and immunosuppression are also associated with severity and death. Another factor associated with death is the presence of neurological disease. The SARS-CoV-2 B1.1.519 variant increases the odds of death compared to the SARS-CoV-2 AY.20 variant.

SARS-CoV-2 versus Influenza A Virus: Characteristics and Co-Treatments

For three years, the novel coronavirus disease 2019 (COVID-19) pandemic, caused by infection of the SARS-CoV-2 virus, has completely changed our lifestyles and prepared us to live with this novel pneumonia for years to come. Given that pre-existing flu is caused by the influenza A virus, we have begun unprecedently co-coping with two different respiratory diseases at the same time. Hence, we draw a comparison between SARS-CoV-2 and influenza A virus based on the general characteristics, especially the main variants’ history and the distribution of the two viruses. SARS-CoV-2 appeared to mutate more frequently and independently of locations than the influenza A virus. Furthermore, we reviewed present clinical trials on combined management against COVID-19 and influenza in order to explore better solutions against both at the same time.

Using publicly available data to identify priority communities for a SARS-CoV-2 testing intervention in a southern U.S. state

Background

The U.S. Southeast has a high burden of SARS-CoV-2 infections and COVID-19 disease. We used public data sources and community engagement to prioritize county selections for a precision population health intervention to promote a SARS-CoV-2 testing intervention in rural Alabama during October 2020 and March 2021.

Methods

We modeled factors associated with county-level SARS-CoV-2 percent positivity using covariates thought to associate with SARS-CoV-2 acquisition risk, disease severity, and risk mitigation practices. Descriptive epidemiologic data were presented to scientific and community advisory boards to prioritize counties for a testing intervention.

Results

In October 2020, SARS-CoV-2 percent positivity was not associated with any modeled factors. In March 2021, premature death rate (aRR 1.16, 95% CI 1.07, 1.25), percent Black residents (aRR 1.00, 95% CI 1.00, 1.01), preventable hospitalizations (aRR 1.03, 95% CI 1.00, 1.06), and proportion of smokers (aRR 0.231, 95% CI 0.10, 0.55) were associated with average SARS-CoV-2 percent positivity. We then ranked counties based on percent positivity, case fatality, case rates, and number of testing sites using individual variables and factor scores. Top ranking counties identified through factor analysis and univariate associations were provided to community partners who considered ongoing efforts and strength of community partnerships to promote testing to inform intervention.

Conclusions

The dynamic nature of SARS-CoV-2 proved challenging for a modelling approach to inform a precision population health intervention at the county level. Epidemiological data allowed for engagement of community stakeholders implementing testing. As data sources and analytic capacities expand, engaging communities in data interpretation is vital to address diseases locally.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

Serum cystatin C and CRP are early predictive biomarkers for emergence of hypoxia in COVID-19

BACKGROUND

In Japan, during the coronavirus disease 2019 (COVID-19) pandemic, patients with non-hypoxia are recommended to recuperate at home or in pre-hospital facilities. However, it was observed that unexpected hypoxia may occur and become severe subsequently in patients whose symptoms were initially expected to improve naturally. The aim of this study is to validate biomarkers that can predict at an early stage the emergence of hypoxia in COVID-19 patients without hypoxia.

METHODS

We retrospectively enrolled 193 patients with COVID-19, excluding patients with hypoxia and severe disease from the onset. Participants were classified into two groups according to the emergence of hypoxia during the clinical course, and the laboratory data were compared to identify biomarkers that could predict early the emergence of hypoxia.

RESULTS

The areas under the curve for serum cystatin C (CysC) and C-reactive protein (CRP) levels for the emergence of hypoxia during the clinical course were higher than those for other biomarkers (CysC, 0.84 and CRP, 0.83). Multivariate analysis showed that high serum CysC and CRP levels were associated with the emergence of hypoxia during the clinical course.

CONCLUSIONS

Elevated serum CysC and CRP levels were associated with the emergence of hypoxia during the clinical course in COVID-19 patients without hypoxia. These findings may help determine the need for hospitalization in initially non-hypoxic COVID-19 patients.

Predicting COVID-19 progression in hospitalized patients in Belgium from a multi-state model

Objectives

To adopt a multi-state risk prediction model for critical disease/mortality outcomes among hospitalised COVID-19 patients using nationwide COVID-19 hospital surveillance data in Belgium.

Materials and methods

Information on 44,659 COVID-19 patients hospitalised between March 2020 and June 2021 with complete data on disease outcomes and candidate predictors was used to adopt a multi-state, multivariate Cox model to predict patients' probability of recovery, critical [transfer to intensive care units (ICU)] or fatal outcomes during hospital stay.

Results

Median length of hospital stay was 9 days (interquartile range: 5-14). After admission, approximately 82% of the COVID-19 patients were discharged alive, 15% of patients were admitted to ICU, and 15% died in the hospital. The main predictors of an increased probability for recovery were younger age, and to a lesser extent, a lower number of prevalent comorbidities. A patient's transition to ICU or in-hospital death had in common the following predictors: high levels of c-reactive protein (CRP) and lactate dehydrogenase (LDH), reporting lower respiratory complaints and male sex. Additionally predictors for a transfer to ICU included middle-age, obesity and reporting loss of appetite and staying at a university hospital, while advanced age and a higher number of prevalent comorbidities for in-hospital death. After ICU, younger age and low levels of CRP and LDH were the main predictors for recovery, while in-hospital death was predicted by advanced age and concurrent comorbidities.

Conclusion

As one of the very few, a multi-state model was adopted to identify key factors predicting COVID-19 progression to critical disease, and recovery or death.

Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: results from the SEMI-COVID-19 registry

INTRODUCTION

Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the coronavirus disease (COVID-19).

METHODS

Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analyzed. A multivariate logistic regression and Kapplan Meier curves analyzed the relationship between smoking and in-hospital mortality.

RESULTS

The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 [59.6-78.0 years]), more frequently male (80.3%) and with higher Charlson index (4 [2-6]) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events.

CONCLUSIONS

Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.

Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study

INTRODUCTION

Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown.

METHODS

Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission.

RESULTS

Current (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06-1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04-1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50-0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16-0.66) and former smokers (aOR, 0.47; 95% CI, 0.39-0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66-0.83) than never smokers (aOR, 0.87; 95% CI, 0.79-0.97).

CONCLUSIONS

Former but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers.

IMPLICATIONS

Prior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.

Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: Results from the SEMI-COVID-19 registry

Introduction

Methods

Results

Conclusions

Tobacco smokers as target group for complicated coronavirus infection

The aim of current study was to determine, retrospectively, possible correlations between smoking and the incidence, course severity, intubation rate, and mortality (by gender and age) in patients treated for complicated coronavirus infection in the internal medicine clinic at UMHATEM ”N. I. Pirogov” Sofia for the period 01.03.2020–31.12.2020. In a prospective study, the recovery period and immunogenesis in smokers and non-smokers within a one-year period after hospital discharge was investigated. The applied methods were: 1) computed tomography and blood gas analysis 2) chemiluminescent immunoassay for the qualitative determination of total IgM, IgA and IgG anti-SARS-CoV2 AB. Results showed that the part of non-smokers with a positive PCR test is significantly higher compared to the group of former and current smokers. The data obtained from the study confirmed that Covid infection is much more severe among smokers and former smokers with a higher levels of inflammatory markers noticed among the smoking group.

E-cigarette use and intentions related to psychological distress among cigarette, e-cigarette, and cannabis vape users during the start of the COVID-19 pandemic

Background

This study examines associations between psychological distress, intentions to use e-cigarettes, and cigarette smoking, e-cigarette use, and cannabis consumption through e-cigarette use among a diverse sample of U.S. young adults.

Procedures

Young adults (N = 314; 72.5% female) were recruited to complete an online survey during the first few months of the COVID-19 pandemic.

Results

Associations between psychological distress and cigarette smoking, e-cigarette use, cannabis vaping, and intentions to use e-cigarettes were found. Current e-cigarette use (OR = 1.23, 95% CI 1.17, 1.28, p < .001; 7.5%) and cannabis vaping (OR = 2.03, 95% CI 1.88, 2.18, p < .001; 10%) was higher among female, possibly due to the significantly higher psychological distress reported among females. Interactions between intentions to use e-cigarettes and psychological distress variables were found for all smoking and vaping behaviors.

Conclusions

Public health efforts should increase focus on providing psychological services for young adults to improve coping strategies that are alternative to smoking and vaping behaviors.

The Impact of Smoking Status and Smoking-Related Comorbidities on Coronavirus Disease 2019 Patient Outcomes: A Causal Mediation Analysis

INTRODUCTION

Smoking history is a known risk factor for significant chronic diseases as well as pulmonary infections; however, the impact of smoking status on coronavirus disease 2019 (COVID-19) outcomes has not been conclusively characterized. This study aims to evaluate the association of smoking status on COVID-19 outcomes, and to explore the mechanism by which smoking and smoking-related comorbidities relate to COVID-19 outcomes.

AIMS AND METHODS

Patients admitted with SARS-CoV-2 infection from November 2020 through January 2021 were included in this study. Causal mediation models investigating the associations between smoking status and the outcomes of mortality, intensive care unit (ICU) admission, advanced respiratory support, mechanical ventilation, ICU length of stay, and hospital length of stay, through mediation via smoking-related comorbidities, were examined.

RESULTS

Active smokers did not experience worse COVID-19 outcomes once hospitalized. Former smokers had a higher odds of mortality (total effect OR 1.59, 95% CI 1.07 to 2.38, p = .01; indirect effect OR 1.45, 95% CI 1.09 to 1.93, p < .001), and advanced respiratory support (total effect OR 1.31, 95% CI 1.04 to 1.67, p = .02; indirect effect OR 1.26, 95% CI 1.03 to 1.54, p = .02), which were mediated by smoking-related comorbidities. While there was a nonsignificant increase in the total effect for mechanical ventilation, smoking-related comorbidities were significant mediators for their increased need (total effect OR 1.40, 95% CI 0.92 to 2.14, p = .13; indirect effect OR 1.47, 95% CI 1.10 to 1.87, p < .001).

CONCLUSIONS

Although active smokers did not experience worse COVID-19 outcomes compared to never smokers, these results should be interpreted with caution. Compared to never smokers, former smokers had greater odds of mortality, advanced respiratory support, and mechanical ventilation which was significantly mediated through smoking-related comorbidities.

IMPLICATIONS

Previous studies have linked smoking status with worse COVID-19 outcomes, and have inferred that smoking-related comorbidities may play a role in these findings. This causal mediation analysis provides statistical evidence supporting this hypothesis, clarifying the risk that smoking-related comorbidities impart on COVID-19 outcomes in those with a smoking history.

Association between smoking and COVID-19 severity: A multicentre retrospective observational study

The relationship between smoking and coronavirus disease 2019 (COVID-19) severity remains unclear. This study aimed to investigate the effect of smoking status (current smoking and a smoking history) on the clinical severity of COVID-19. Data of all enrolled 588 patients, who were referred to 25 hospitals in Jiangsu province between January 10, 2020 and March 14, 2020, were retrospectively reviewed. Univariate and multivariate regression, random forest algorithms, and additive interaction were used to estimate the importance of selective predictor variables in the relationship between smoking and COVID-19 severity. In the univariate analysis, the proportion of patients with a current smoking status in the severe group was significantly higher than that in the non-severe group. In the multivariate analysis, current smoking remained a risk factor for severe COVID-19. Data from the interaction analysis showed a strong interaction between the number of comorbidities in patients with COVID-19 and smoking. However, no significant interaction was found between smoking and specific comorbidities, such as hypertension, diabetes, etc. In the random forest model, smoking history was ranked sixth in mean decrease accuracy. Active smoking may be significantly associated with an enhanced risk of COVID-19 progression towards severe disease. However, additional prospective studies are needed to clarify the complex relationship between smoking and COVID-19 severity.

COVID-19 patients with documented alcohol use disorder or alcohol-related complications are more likely to be hospitalized and have higher all-cause mortality

BACKGROUND

Coronavirus Disease 2019 (COVID-19) has affected every country globally, with hundreds of millions of people infected with the SARS-CoV-2 virus and over 6 million deaths to date. It is unknown how alcohol use disorder (AUD) affects the severity and mortality of COVID-19. AUD is known to increase the severity and mortality of bacterial pneumonia and the risk of developing acute respiratory distress syndrome. Our objective is to determine whether individuals with AUD have increased severity and mortality from COVID-19.

METHODS

We utilized a retrospective cohort study of inpatients and outpatients from 44 centers participating in the National COVID Cohort Collaborative. All were adult COVID-19 patients with and without documented AUDs.

RESULTS

We identified 25,583 COVID-19 patients with an AUD and 1,309,445 without. In unadjusted comparisons, those with AUD had higher odds of hospitalization (odds ratio [OR] 2.00, 95% confidence interval [CI] 1.94 to 2.06, p < 0.001). After adjustment for age, sex, race/ethnicity, smoking, body mass index, and comorbidities, individuals with an AUD still had higher odds of requiring hospitalization (adjusted OR [aOR] 1.51, CI 1.46 to 1.56, p < 0.001). In unadjusted comparisons, individuals with AUD had higher odds of all-cause mortality (OR 2.18, CI 2.05 to 2.31, p < 0.001). After adjustment as above, individuals with an AUD still had higher odds of all-cause mortality (aOR 1.55, CI 1.46 to 1.65, p < 0.001).

CONCLUSION

This work suggests that AUD can increase the severity and mortality of COVID-19 infection. This reinforces the need for clinicians to obtain an accurate alcohol history from patients hospitalized with COVID-19. For this study, our results are limited by an inability to quantify the daily drinking habits of the participants. Studies are needed to determine the mechanisms by which AUD increases the severity and mortality of COVID-19.

Shared genomic architecture between COVID-19 severity and numerous clinical and physiologic parameters revealed by LD score regression analysis

The COVID-19 pandemic has produced broad clinical manifestations, from asymptomatic infection to hospitalization and death. Despite progress from genomic and clinical epidemiology research, risk factors for developing severe COVID-19 are incompletely understood and identification of modifiable risk factors is desperately needed. We conducted linkage disequilibrium score regression (LDSR) analysis to estimate cross-trait genetic correlation between COVID-19 severity and various polygenic phenotypes. To attenuate the genetic contribution of smoking and BMI, we further conducted sensitivity analyses by pruning genomic regions associated with smoking/BMI and repeating LDSR analyses. We identified robust positive associations between the genetic architecture of severe COVID-19 and both BMI and smoking. We observed strong positive genetic correlation (rg) with diabetes (rg = 0.25) and shortness of breath walking on level ground (rg = 0.28) and novel protective associations with vitamin E (rg = - 0.53), calcium (rg = - 0.33), retinol (rg = - 0.59), Apolipoprotein A (rg = - 0.13), and HDL (rg = - 0.17), but no association with vitamin D (rg = - 0.02). Removing genomic regions associated with smoking and BMI generally attenuated the associations, but the associations with nutrient biomarkers persisted. This study provides a comprehensive assessment of the shared genetic architecture of COVID-19 severity and numerous clinical/physiologic parameters. Associations with blood and plasma-derived traits identified biomarkers for Mendelian randomization studies to explore causality and nominates therapeutic targets for clinical evaluation.

Factors affecting the COVID-19 risk in the US counties: an innovative approach by combining unsupervised and supervised learning

The COVID-19 disease spreads swiftly, and nearly three months after the first positive case was confirmed in China, Coronavirus started to spread all over the United States. Some states and counties reported high number of positive cases and deaths, while some reported lower COVID-19 related cases and death. In this paper, the factors that could affect the risk of COVID-19 infection and death were analyzed in county level. An innovative method by using K-means clustering and several classification models is utilized to determine the most critical factors. Results showed that longitudinal coordinate and population density, latitudinal coordinate, percentage of non-white people, percentage of uninsured people, percent of people below poverty, percentage of Elderly people, number of ICU beds per 10,000 people, percentage of smokers were the most significant attributes.

Reply to "COVID-19 and smoking: an opportunity to quit….when vaccinated!"

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.arbres.2021.05.029 . The duplicate article has therefore been withdrawn.

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Outcomes of Patients with COPD Hospitalized for Coronavirus Disease 2019

RATIONALE

There is controversy concerning the association of chronic obstructive pulmonary disease (COPD) as an independent risk factor for mortality in patients hospitalized with Coronavirus Disease 2019 (COVID-19). We hypothesize that patients with COPD hospitalized for COVID-19 have increased mortality risk.

OBJECTIVE

To assess whether COPD increased the risk of mortality among patients hospitalized for COVID-19.

METHODS

We conducted a retrospective cohort analysis of patients with COVID-19 between February 10, 2020, and November 10, 2020, and hospitalized within 14 days of diagnosis. Electronic health records from U.S. facilities (Optum COVID-19 data) were used.

RESULTS

In our cohort of 31,526 patients, 3030 (9.6%) died during hospitalization. Mortality in patients with COPD was higher than that of patients without COPD, 14.02% and 8.8%, respectively. Univariate (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.54 to 1.84) and multivariate (OR 1.33; 95% CI 1.18 to 1.50) analysis showed that patients with COPD had greater odds of death due to COVID-19 than patients without COPD. We found significant interactions between COPD and sex and COPD and age. Specifically, the increased mortality risk associated with COPD was observed among female (OR 1.62; 95% CI 1.36 to 1.95) but not male patients (OR 1.14; 95% CI 0.97 to 1.34); and in patients aged 40 to 64 (OR 1.42; 95% CI 1.07 to 1.90) and 65 to 79 (OR 1.48; 95% CI 1.23 to 1.78) years.

CONCLUSIONS

COPD is an independent risk factor for death in adults aged 40 to 79 years hospitalized with COVID-19 infection.

Smoking Status and Factors associated with COVID-19 In-hospital Mortality among U.S. Veterans

Introduction

The role of smoking in risk of death among patients with COVID-19 remains unclear. We examined the association between in-hospital mortality from COVID-19 and smoking status and other factors in the United States Veterans Health Administration (VHA).

Methods

This is an observational, retrospective cohort study using the VHA COVID-19 shared data resources for February 1 to September 11, 2020. Veterans admitted to the hospital who tested positive for SARS-CoV-2 and hospitalized by VHA were grouped into Never (as reference, NS), Former (FS), and Current smokers (CS). The main outcome was in-hospital mortality. Control factors were the most important variables (among all available) determined through a cascade of machine learning. We reported adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models, imputing missing smoking status in our primary analysis.

Results

Out of 8 667 996 VHA enrollees, 505 143 were tested for SARS-CoV-2 (NS = 191 143; FS = 240 336; CS = 117 706; Unknown = 45 533). The aOR of in-hospital mortality was 1.16 (95%CI 1.01, 1.32) for FS vs. NS and 0.97 (95%CI 0.78, 1.22; p > .05) for CS vs. NS with imputed smoking status. Among other factors, famotidine and nonsteroidal anti-inflammatory drugs (NSAID) use before hospitalization were associated with lower risk while diabetes with complications, kidney disease, obesity, and advanced age were associated with higher risk of in-hospital mortality.

Conclusions

In patients admitted to the hospital with SARS-CoV-2 infection, our data demonstrate that FS are at higher risk of in-hospital mortality than NS. However, this pattern was not seen among CS highlighting the need for more granular analysis with high-quality smoking status data to further clarify our understanding of smoking risk and COVID-19-related mortality. Presence of comorbidities and advanced age were also associated with increased risk of in-hospital mortality.

Implications

Veterans who were former smokers were at higher risk of in-hospital mortality compared to never smokers. Current smokers and never smokers were at similar risk of in-hospital mortality. The use of famotidine and nonsteroidal anti-inflammatory drugs (NSAIDs) before hospitalization were associated with lower risk while uncontrolled diabetes mellitus, advanced age, kidney disease, and obesity were associated with higher risk of in-hospital mortality.