Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Smoking enhances the expression of Angiotensin-converting enzyme 2 (ACE2) receptors, potentially increasing the risk of severe COVID-19. Paradoxical findings from early waves of the pandemic have associated smoking with decreased risk of severe COVID-19
due to some methodological gaps such as the reliance on records linkage.
Research Question or Hypothesis: Does smoking status affect COVID-19 severity measured by the WHO ordinal COVID-19 severity scale?
Study Design: A retrospective observational cohort study was conducted using patient chart review data from a large tertiary medical center in Saudi Arabia.
Methods: Patients admitted between January and December 2020 for COVID-19 were screened. Inclusion criteria: patients = 18 years old with confirmed SARS CoV 2 infection via RT-PCR. Exclusion criteria: non-confirmed COVID-19, non-COVID-19 admissions, unconfirmed smoking status, vaccinated individuals, or refusal to consent. Analytical approaches included crude estimates, matching weights, and directed acyclic graph (DAG) causal pathway analysis with ordinal regression model.
Results: A total of 447 patients were included in our study (ever-smoker n=126; never-smoker=321) with a median age of 50 years (interquartile range of 39.0 to 58.0 years) and 73.4% of the cohort were male patients. Covariate balance was achieved by the matching weights procedure. In the matching weights analysis, there was an increase in the odds of acquiring severe COVID-19 disease in the ever-smoker group with an odds ratio (OR) of 1.44 (95% CI 0.90 to 2.32, P=0.130). This increase in odds was mainly driven by the higher use of non-invasive oxygen therapy in the ever-smoker group (7.4% vs 2.7%) with an OR of 1.05 (99% CI 0.99 to 1.10, P=0.101). These findings were consistent in the crude estimates and DAG pathway analysis.
Conclusion: The findings of this study suggest that smoking may increase the risk of severe COVID-19 disease. However, the study was limited by its sample size and retrospective design. Further research is needed to confirm these findings.
Presenting Author
Ahmad Alamer PharmD, BC-ADMPrince Sattam Bin Abdulaziz University
Authors
Lina Al Lehaibi Pharm.D, BCPS
Eastern Health Cluster, Saudi Arabia
Fawaz Alasmari PhD
King Saud University
Mashael Alghamdi MPH
Saudi National Health Institute
Mukhtar Alomar PharmD, BCPS
Dammam Medical Complex
Haneen Alotaibi PharmD Candidate
King Saud University
Faleh Alqahtani PhD
King Saud University
Musaad A. Alshammari PhD
King Saud University
Tahani K. Alshammari PhD
King Saud University