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

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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.

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Acknowledgments

The authors acknowledge the support and contribution from the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resource Evaluation. This study was not funded by the NIH, the Wellcome Trust or the NHMRC.

Conflicts of interest

None of the authors have any financial relationships or non-financial interests that may be relevant to the submitted work.

Author information

Authors and Affiliations

  1. Intensive Care Unit, Royal Perth Hospital, Perth, 6000, Australia

    Kwok M. Ho

  2. School of Population Health, University of Western Australia, Perth, Australia

    Kwok M. Ho

  3. Austin Centre for Applied Clinical Informatics, Austin Health, Melbourne, Australia

    Graeme Hart

  4. University of Melbourne, Melbourne, Australia

    Graeme Hart

  5. Rockhampton Hospital, Rockhampton, QLD, Australia

    David Austin

  6. Dunedin Hospital, Otago District Health Board, Private Bag 1921, Dunedin, New Zealand

    Mike Hunter

  7. Frankston Hospital, Frankston, Australia

    John Botha

  8. Monash University, Melbourne, VIC, Australia

    John Botha

  9. Australian and New Zealand Intensive Care Society, Centre for Outcome and Resource Evaluation, Melbourne, Australia

    Shaila Chavan

Authors
  1. Kwok M. Ho
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  2. Graeme Hart
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  3. David Austin
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  4. Mike Hunter
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  5. John Botha
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  6. Shaila Chavan
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Corresponding author

Correspondence to Kwok M. Ho.

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Ho, K.M., Hart, G., Austin, D. et al. Dose-related effect of smoking on mortality in critically ill patients: a multicentre cohort study. Intensive Care Med 37, 981–989 (2011). https://doi.org/10.1007/s00134-011-2184-6

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  • DOI: https://doi.org/10.1007/s00134-011-2184-6

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