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

  1. Ana C. Monteiro
  2. Rajat Suri
  3. Iheanacho O. Emeruwa
  4. Robert J. Stretch
  5. Roxana Y. Cortes-Lopez
  6. Alexander Sherman
  7. Catherine C. Lindsay
  8. Jennifer A. Fulcher
  9. David Goodman-Meza
  10. Anil Sapru
  11. Russell G. Buhr
  12. Steven Y. Chang
  13. Tisha Wang
  14. Nida Qadir

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Abstract

To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV).

Materials and methods

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.

Results

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.

Conclusions

Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

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  1. Version published to 10.1371/journal.pone.0238552
  2. ScreenIT

    SciScore for 10.1101/2020.08.12.20173849: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Setting, Patient Population, and Study Design: This is a retrospective observational cohort study conducted from March 12 2020 and April 16 2020 approved by the UCLA (University of California, Los Angeles) institutional review board with waiver of informed consent.
    Consent: Setting, Patient Population, and Study Design: This is a retrospective observational cohort study conducted from March 12 2020 and April 16 2020 approved by the UCLA (University of California, Los Angeles) institutional review board with waiver of informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Study weaknesses included the single center nature and small sample size, which precluded more robust evaluation of risk factors associated with mortality. In addition, short follow up times precluded the assessment of disease sequela in our cohort. We also did not collect information on social determinants of health such as education level, insurance status or economic factors, all of which could have influenced observed outcomes. Finally, given its retrospective nature, we also cannot ascertain that any of our interventions directly affected patient outcomes. Nevertheless, our data identified potential risk factors for disease progression.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04315298CompletedEvaluation of the Efficacy and Safety of Sarilumab in Hospit…
    NCT04280705CompletedAdaptive COVID-19 Treatment Trial (ACTT)
    NCT04347239RecruitingStudy to Evaluate the Efficacy and Safety of Leronlimab for …
    NCT04332991CompletedOutcomes Related to COVID-19 Treated With Hydroxychloroquine…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

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  3. Version published to 10.1101/2020.08.12.20173849v1 on medRxiv