Demet TURAN, Binnaz Zeynep YILDIRIM, Mehmet Akif ÖZGÜL, Efsun Gonca UĞUR CHOUSEIN, Elif TANRIVERDİ, Mustafa ÇÖRTÜK, Halit CINARKA, Celal Buğra SEZEN

COVID-19 pnömonisi ile yatan hastalarda sigara öyküsünün hastalık şiddetli ve mortalitesi üzerinde bir etkisi var mı?

Giriş: Çin’de ortaya çıkarak tüm dünyaya yayılan Severe acute respiratory syndrome (SARS-CoV-2) virüsü, her açıdan dünyayı etkile-miştir ve daha da etkileyecek gibi görünmektedir. Asemptomatik bir klinikten, yoğun bakım ihtiyacı ve ölüm ile sonuçlanabilen alt solunum yolu enfeksiyonu tablosuna kadar uzanan farklı ağırlıkta tablolara yol açmıştır. Bu çalışma primer olarak akciğeri etkileyen yol açtığı COVID-19 hastalığında sigaranın prognoz üzerindeki olası ağırlaştırıcı etkisini araştırmak amaçlı yapılmıştır.Materyal ve Metod: 11 Mart 2020 ve 30 Nisan 2020 arasında kliniğimizde COVID-19 pnömonisi tanısı ile yatarak tedavi gören, 114 erişkin hasta çalışmaya alınmış ve retrospektif olarak; özellikle sigara öyküleri, hastane başvurusu öncesi semptomları ve süresi, has-talığın ciddiyet derecesi, yatışları boyunca gerek duyulan NIMV, ICU ihtiyaçları ve mortalite açısından değerlendirilmiştr.Bulgular: COVID-19 tanısı ile yatan 114 hastanın yaş ortalaması 51.14 ± 14.97 (range 16-81), ve 77 (%67.5)‘si erkekti. Hastaların 19’u (%15.9) aktif sigara içici, 23’ü ex-smoker (%20.1) 72’si (%63.1) hiç sigara içmemiş idi. Bu oranlar aktif sigara içici ve ex-smokerlar için toplum ortalamasından düşüktü. Sigara içiciliğin hastalığın hafif ya da ağır olması üzerinde, hastanede kalış süresi, non invazif mekanik ventilasyon (NIMV), yoğun bakım ünitesi (YBÜ) ve mortalite üzerinde etkisi istatistiksel olarak anlamlı değildi.sonuç: COVID-19 tanısı ile yatan hastalarda aktif sigara içme oranı toplum ortalamasından düşüktür. Sigara içiciliğin; hastalığın hafif ya da ağır olması üzerinde etkili olmadığı, prognostik göstergeler ve mortalite ile ilişkili olmadığı görülmüştür. Sigara ve COVID-19 ilişkisi ve hastalık üzerindeki etkisi için daha büyük hasta sayıları ile ve mekanizmalar açısından daha ileri çalışmalara ve vaka serile-rine ihtiyaç vardır.

Is there any effect of smoking status on severity and mortality of hospitalized patients with COVID-19 pneumonia?

Introduction: The Severe Acute Respiratory Syndrome (SARS-CoV-2) virus, which emerged from China and spread all over the world, has affected the world in every aspect and will do so in the foreseeable future. This study was carried out to investigate the possible aggravating effect of smoking on the prognosis of patients with COVID-19 pneumonia presenting with pulmonary involvement.Materials and Methods: 114 adult patients who received inpatient treatment in our clinic with the diagnosis of COVID-19 pneumonia between 11 March 2020 and 30 April 2020 were retrospectively included in the study; in parti-cular, they were evaluated in terms of smoking history, severity of disease, need for NIMV and ICU admission, and mortality during their hospitalization.results: The mean age of the 114 patients hospitalized with COVID-19 pneu-monia was 51.14 ± 14.97 (range 16-81), and 77 (67.5%) were male. Of the patients, 19 (15.9%) were active smokers, 23 were ex-smokers (20.1%), 72 (63.1%) non-smokers. The effect of smoking on the severity of the disease, length of hospitalization, need for non-invasive mechanical ventilation (NIMV) and intensive care unit (ICU) admission and mortality were not sta-tistically significant.Conclusion: The rate of active smoking in patients hospitalized with COVID-19 is lower than the population average. In this study, no correlation was observed between smoking status and the severity, prognosis and mortality of the disease. Further studies with larger number of patients and case series are needed to better elucidate the relationship between smoking and COVID-19 and the pathophysiologic mechanisms of the effects of smoking on the natural history of COVID-19 pneumonia.

PDF

___

1. Dai H, Zhang X, Xia J, Zhang T, Shang Y, Huang R, et al. High-resolution Chest CT Features and Clinical Characteristics of Patients Infected with COVID-19 in Jiangsu, China. Int J Infect Dis 2020; 95: 106-12.
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
3. World Health Organization (WHO). Current cigarette smoking rate-trends in prevalence of tobacco smoking: global level in: Global World report on trends in prevelance of tobacco smoking: 2000-2025: 11-25. WHO.
4. Republic of Turkey Ministry of Health. Public Health Institution of Turkey Department of Combating Tobacco and Substance Addiction. Global Adult Tobacco Survey Turkey Report 2012: 10-12.
5. Winnall WR, Bellew B, Greenhalgh EM, Winstanley MH. Increased susceptibility to infection in smokers. In: Greenhalgh EM, Scoll, MM, Winstanley MH (eds). Tobacco In Australia: Facts And Issues. Melbourne: Cancer Council Victoria; 2020.
6. Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, et al. The socio-economic implications of the coronavirus and COVID-19 pandemic: a review. Int J Surg 2020; 78: 185-93.
7. Yezli S, Khan A. COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges. Travel Med Infect Dis 2020; 101692.
8. Patanavanich R, Glantz SA. Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine Tob Res 2020; 22(9): 1653-6.
9. Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med 2020; 75: 107-8.
10. Forsslund H, Mikko M, Karimi R, Grunewald J, Wheelock AM, Wahlstrom J, et al. Distribution of T-cell subsets in BAL fluid of patients with mild to moderate COPD depends on current smoking status and not airway obstruction. Chest 2014; 145: 711-22.
11. Tollerud DJ, Clark JW, Brown LM, Neuland CY, Mann DL, Pankiw-Trost LK, et al. Association of cigarette smoking with decreased numbers of circulating natural killer cells. Am Rev Respir Dis 1989; 139(1): 194-8.
12. Ganjia A, Farahani I, Khansarinejada B, Ghazavib A, Mosayebi G. Increased expression of CD8 marker on T-cells in COVID-19 patients. Blood Cells Mol Dis 2020; 83: 102437.
13. Liao M, Liu Y, Yuan J, Wen Y, Xu G, Zhao J, et al. Single-cell landscape of bronchoalveolar immune cells in patients with COVID-19. Nat Med 2020; 26(6): 842-4.
14. García LF. Immune response, inflammation, and the clinical spectrum of COVID-19. Front Immunol 2020; 11: 1441.
15. Cai G, Bossé Y, Xiao F, Kheradmand F, Amos CI. Tobacco smoking increases the lung gene expression of ACE2, the receptor of SARS-CoV-2. Am J Respir Crit Care Med 2020 Jun 15; 201(12): 1557-9.
16. 16-Miyara M, Tubach F, Pourcher V, Morelot-Panzini C, Pernet J, Haroche J, et al. Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19. Qeios 2020; 1-13.
17. Zhang J, Dong X, Cao Y, Yuan Y, Yang Y, Yan Y, Akdis CA, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020; 75: 1730-41.
18. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20.
19. Liu H, Chen S, Liu M, Nie H, Lu H. Comorbid chronic diseases are strongly correlated with disease severity among COVID-19 patients: a systematic review and metaanalysis. Aging Dis 2020; 11(3): 668-78.
20. Sanchez-Ramirez DC, Mackey D. Underlying respiratory diseases, specifically COPD, and smoking are associated with severe COVID-19 outcomes: A systematic review and meta-analysis. Respir Med 2020; 171: 106096.
21. Luo J, Rizvi H, Preeshagul IR, Egger JV, Hoyos D, Bandlamudi C, et al. COVID-19 in patients with lung cancer. Ann Oncol 2020; 31(10): 1386-96.
22. Leung JM, Niikura M, Yang CWT, Sin DD. COVID-19 and COPD. Eur Respir J 2020; 56: 2002108.
23. Karanasos A, Aznaouridis K, Latsios G, Synetos A, Plitaria S, Tousoulis D, et al. Impact of smoking status on disease severity and mortality of hospitalized patients with COVID- 19 infection: a systematic review and meta-analysis. Nicot Tob Res 2020; 1657-9.
24. Grundy EJ, Suddek T, Filippidis FT, Majeed A, Coronini- Cronberg S. Smoking, SARS-CoV-2 and COVID-19: A review of reviews considering implications for public health policy and practice. Tob Induc Dis 2020; 18: 58.
25. Simons D, Shahab L, Brown J, Perski O. The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review. Qeios 2020.
26. Saldías F, Díaz O. Cigarette smoking and lower respiratory tract infection. In: Martin-Loeches I (ed). Bronchitis. InTech, 2011.