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

• Published in: PloS one Vol. 15; no. 12; p. 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: Journal Article
• Language: English
• Published: United States Public Library of Science 22.12.2020; Public Library of Science (PLoS)
• 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; United States; Los Angeles California; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0238552

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.