Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study

To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extract...

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Bibliographic Details
Published in:	PloS one 2020-12, Vol.15 (12), p.e0238552-e0238552
Main Authors:	Monteiro, Ana C, Suri, Rajat, Emeruwa, Iheanacho O, Stretch, Robert J, Cortes-Lopez, Roxana Y, Sherman, Alexander, Lindsay, Catherine C, Fulcher, Jennifer A, Goodman-Meza, David, Sapru, Anil, Buhr, Russell G, Chang, Steven Y, Wang, Tisha, Qadir, Nida
Format:	Article
Language:	eng
Subjects:	Aged Anticoagulants Artificial respiration Biology and Life Sciences C-Reactive Protein Cell number Clinical trials Cohort analysis Cohort Studies Complications and side effects Coronaviruses COVID-19 COVID-19 - blood COVID-19 - complications COVID-19 - epidemiology COVID-19 - virology Critical care Electronic health records Electronic medical records Female Ferritin Ferritins - blood Health aspects Health risks Hospital Mortality Hospital systems Hospitals Humans Infectious diseases Inflammation Intensive Care Units Interleukin 6 Interleukin-6 - blood Intubation L-Lactate Dehydrogenase - blood Lymphocyte Count Lymphocytes Male Markers Mechanical properties Mechanical ventilation Medicine Medicine and Health Sciences Methods Middle Aged Mortality Obesity Obesity - blood Obesity - complications Obesity - epidemiology Obesity - virology Observational studies Patients Procalcitonin Procalcitonin - blood Regression analysis Respiration, Artificial Respiratory distress syndrome Respiratory failure Respiratory Insufficiency - blood Respiratory Insufficiency - complications Respiratory Insufficiency - epidemiology Respiratory Insufficiency - virology Retrospective Studies Risk analysis Risk Factors SARS-CoV-2 - pathogenicity Severe acute respiratory syndrome coronavirus 2 Smoking Smoking - adverse effects Ventilation Ventilators
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Summary:	To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Our cohort had median age of 61 (IQR 45-74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74-19.48), former (OR 8.06, CI 1.51-43.06) and current smoking status (OR 10.33, CI 1.43-74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11-0.96), procalcitonin (OR 1.27, CI 1.02-1.57), IL-6 (OR 1.17, CI 1.03-1.33), ferritin (OR 1.05, CI 1.005-1.11), LDH (OR 1.57, 95% CI 1.13-2.17) and CRP (OR 1.13, CI 1.06-1.21), were associated with IMV by univariate analysis. Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.
ISSN:	1932-6203 1932-6203