PT  - JOURNAL ARTICLE
AU  - Carolina Espejo-Paeres
AU  - Iván J Núñez-Gil
AU  - Vicente Estrada
AU  - Cristina Fernández-Pérez
AU  - Giovanna Uribe-Heredia
AU  - Clara Cabré-Verdiell
AU  - Aitor Uribarri
AU  - Rodolfo Romero
AU  - Marcos García-Aguado
AU  - Inmaculada Fernández-Rozas
AU  - Victor Becerra-Muñoz
AU  - Martino Pepe
AU  - Enrico Cerrato
AU  - Sergio Raposeiras-Roubín
AU  - María Barrionuevo-Ramos
AU  - Freddy Aveiga-Ligua
AU  - Carolina Aguilar-Andrea
AU  - Emilio Alfonso-Rodríguez
AU  - Fabrizio Ugo
AU  - Juan Fortunato García-Prieto
AU  - Gisela Feltes
AU  - Ibrahim Akin
AU  - Jia Huang
AU  - Jorge Jativa
AU  - Antonio Fernández-Ortiz
AU  - Carlos Macaya
AU  - Ana Carrero-Fernández
AU  - Jaime Signes-Costa
TI  - Impact of smoking on COVID-19 outcomes: a HOPE Registry subanalysis
AID  - 10.1136/bmjnph-2021-000269
DP  - 2021 Jun 16
TA  - BMJ Nutrition, Prevention & Health
PG  - bmjnph-2021-000269
4099  - http://nutrition.bmj.com/content/early/2021/06/16/bmjnph-2021-000269.short
4100  - http://nutrition.bmj.com/content/early/2021/06/16/bmjnph-2021-000269.full
AB  - Background Smoking has been associated with poorer outcomes in relation to COVID-19. Smokers have higher risk of mortality and have a more severe clinical course. There is paucity of data available on this issue, and a definitive link between smoking and COVID-19 prognosis has yet to be established.Methods We included 5224 patients with COVID-19 with an available smoking history in a multicentre international registry Health Outcome Predictive Evaluation for COVID-19 (NCT04334291). Patients were included following an in-hospital admission with a COVID-19 diagnosis. We analysed the outcomes of patients with a current or prior history of smoking compared with the non-smoking group. The primary endpoint was all-cause in-hospital death.Results Finally, 5224 patients with COVID-19 with available smoking status were analysed. A total of 3983 (67.9%) patients were non-smokers, 934 (15.9%) were former smokers and 307 (5.2%) were active smokers. The median age was 66 years (IQR 52.0–77.0) and 58.6% were male. The most frequent comorbidities were hypertension (48.5%) and dyslipidaemia (33.0%). A relevant lung disease was present in 19.4%. In-hospital complications such sepsis (23.6%) and embolic events (4.3%) occurred more frequently in the smoker group (p<0.001 for both). All cause-death was higher among smokers (active or former smokers) compared with non-smokers (27.6 vs 18.4%, p<0.001). Following a multivariate analysis, current smoking was considered as an independent predictor of mortality (OR 1.77, 95% CI 1.11 to 2.82, p=0.017) and a combined endpoint of severe disease (OR 1.68, 95% CI 1.16 to 2.43, p=0.006).Conclusion Smoking has a negative prognostic impact on patients hospitalised with COVID-19.Data are available upon reasonable request (Health Outcome Predictive Evaluation for COVID-19 Registry).