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Dose-related effect of smoking on mortality in critically ill patients: a multicentre cohort study

Kwok M. Ho| Graeme Hart| David Austin| Mike Hunter| John Botha| Shaila Chavan
Original
Volume 37, Issue 6 / June , 2011

Pages 981 - 989

Abstract

Purpose

It is uncertain whether smoking has an independent dose-related adverse effect on mortality in critically ill patients. This study assessed whether the intensity of smoking history, measured in pack-years, has a dose-related effect on mortality in critically ill patients.

Methods

In this multicentre cohort study data were collected from six tertiary intensive care units (ICU) in Australia and New Zealand.

Results

Of the 8,962 patients considered in the study, data on patients’ smoking status and smoking history were available from 5,063 and 2,865 patients, respectively. Male gender, and chronic respiratory, liver and cardiovascular diseases were over-represented among smokers compared to non-smokers. Smokers had a higher risk of requiring mechanical ventilation and dying in hospital than non-smokers (10.7% vs. 6.7%, p = 0.001), particularly after emergency admission. Smokers also had a longer ICU stay than non-smokers (mean 3.2 days, interquartile range 0.8–3.2 vs. 2.8 days, interquartile range 0.8–2.9; p = 0.024). After adjusting for age, gender, elective surgical admission, severity of acute illness, and severe chronic illnesses, the intensity of smoking history remained significantly associated with the risk of dying in hospital. This was in a relatively linear fashion (odds ratio 1.08 per 10 pack-years increment, 95% confidence interval 1.02–1.15; p = 0.02). Further grouping of smokers into active smokers and ex-smokers, or including patients with unknown smoking status in the sensitivity analyses did not change the association between the intensity of smoking history and mortality.

Conclusions

Smoking has a dose-related adverse effect on mortality of critically ill patients after adjusting for other confounders.

Keywords

References

  1. Afessa B, Keegan MT (2010) Critical care support of patients with nicotine addiction. Crit Care 14:155
    • View reference on PubMed
    • View reference on publisher's website
  2. Kenfield SA, Wei EK, Rosner BA, Glynn RJ, Stampfer MJ, Colditz GA (2010) Burden of smoking on cause-specific mortality: application to the Nurses’ Health Study. Tob Control 19:248–254
    • View reference on PubMed
    • View reference on publisher's website
  3. Stolzmann KL, Gagnon DR, Brown R, Tun CG, Garshick E (2010) Risk factors for chest illness in chronic spinal cord injury: a prospective study. Am J Phys Med Rehabil 89:576–583
    • View reference on PubMed
    • View reference on publisher's website
  4. Finklea JD, Khan G, Thomas S, Song J, Myers D, Arroliga AC (2010) Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med 104:816–821
    • View reference on PubMed
    • View reference on publisher's website
  5. Björck L, Rosengren A, Wallentin L, Stenestrand U (2009) Smoking in relation to ST-segment elevation acute myocardial infarction: findings from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions. Heart 95:1006–1011
    • View reference on PubMed
    • View reference on publisher's website
  6. Sims M, Maxwell R, Bauld L, Gilmore A (2010) Short term impact of smoke-free legislation in England: retrospective analysis on hospital admissions for myocardial infarction. BMJ 340:c2161
    • View reference on PubMed
    • View reference on publisher's website
  7. Turunen P, Wikström H, Carpelan-Holmström M, Kairaluoma P, Kruuna O, Scheinin T (2010) Smoking increases the incidence of complicated diverticular disease of the sigmoid colon. Scand J Surg 99:14–17
    • View reference on PubMed
  8. Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L (2009) Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 13:R77
    • View reference on PubMed
    • View reference on publisher's website
  9. Pittet D, Thiévent B, Wenzel RP, Li N, Gurman G, Suter PM (1993) Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 19:265–272
  10. Shah RS, Cole JW (2010) Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther 8:917–932
    • View reference on PubMed
    • View reference on publisher's website
  11. Holst AG, Jensen G, Prescott E (2010) Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation 121:1896–1903
    • View reference on PubMed
    • View reference on publisher's website
  12. Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM (2009) Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth 102:297–306
    • View reference on PubMed
    • View reference on publisher's website
  13. Leithead JA, Ferguson JW, Hayes PC (2008) Smoking-related morbidity and mortality following liver transplantation. Liver Transpl 14:1159–1164
    • View reference on PubMed
    • View reference on publisher's website
  14. Neuner B, Miller P, Wang KK, Weiss-Gerlach E, Neumann T, Schoenfeld H et al (2010) Socioeconomic factors, hazardous alcohol consumption, and smoking in patients with minor trauma in an inner-city emergency department. J Emerg Med 39:554–560
    • View reference on PubMed
    • View reference on publisher's website
  15. Gariballa S, Forster S (2009) Effects of smoking on nutrition status and response to dietary supplements during acute illness. Nutr Clin Pract 24:84–90
    • View reference on PubMed
    • View reference on publisher's website
  16. Münzel T, Sinning C, Post F, Warnholtz A, Schulz E (2008) Pathophysiology, diagnosis and prognostic implications of endothelial dysfunction. Ann Med 40:180–196
    • View reference on PubMed
    • View reference on publisher's website
  17. McMaster SK, Paul-Clark MJ, Walters M, Fleet M, Anandarajah J, Sriskandan S et al (2008) Cigarette smoke inhibits macrophage sensing of Gram-negative bacteria and lipopolysaccharide: relative roles of nicotine and oxidant stress. Br J Pharmacol 153:536–543
    • View reference on PubMed
    • View reference on publisher's website
  18. Unverdorben M, von Holt K, Winkelmann BR (2009) Smoking and atherosclerotic cardiovascular disease: part III: Functional biomarkers influenced by smoking. Biomark Med 3:807–823
    • View reference on PubMed
    • View reference on publisher's website
  19. Cuvas O, Er A, Ikeda OC, Dikmen B, Basar H (2008) Cigarette smoking and the haemodynamic response to tracheal intubation. Anaesthesia 63:463–466
    • View reference on PubMed
    • View reference on publisher's website
  20. Spragg RG, Lewis JF, Walmrath HD, Johannigman J, Bellingan G, Laterre PF et al (2004) Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome. N Engl J Med 351:884–892
    • View reference on PubMed
    • View reference on publisher's website
  21. Australian and New Zealand Intensive Care Society: Database Management Committee. http://www.anzics.com.au/article.asp?Section=dmg&ID=31
  22. Harrell FE Jr (2001) Regression modeling strategies. Springer, New York
  23. Ho KM, Knuiman M, Finn J, Webb SA (2008) Estimating long-term survival of critically ill patients: the PREDICT model. PLoS One 3:e3226
    • View reference on PubMed
    • View reference on publisher's website
  24. Cantin AM (2010) Cellular response to cigarette smoke and oxidants: adapting to survive. Proc Am Thorac Soc 7:368–375
    • View reference on PubMed
    • View reference on publisher's website
  25. Rosenbaum PR (2003) Does a dose-response relationship reduce sensitivity to hidden bias? Biostatistics 4:1–10
    • View reference on PubMed
    • View reference on publisher's website

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