Exposure to sulfur mustard increases the risk for mortality in patients with COVID-19 infection: A cohort study

https://doi.org/10.1016/j.ajem.2021.09.053Get rights and content

Highlights

  • Patients with SME have an increased risk for mortality from COVID-19.

  • The healthcare setting should be ready to provide more intensive care for patients with SME.

  • Patients with SME are more likely to have asthma or pulmonary disease other than asthma.

  • We recommend O2 therapy early at admission, particularly for patients with SME.

Abstract

Objective

This study aims to assess the prognosis of inpatients with COVID-19 infection who have a history of sulfur mustard exposure.

Methods

We started a cohort study in October 2020 and ended in May 2021 on inpatients with COVID-19 infection who had been admitted to university healthcare centers. The analytic sample included 960 inpatients having COVID-19 infection (192 with; and 768 without sulfur mustard exposure). The exposed patients were male war veterans, and the unexposed patients were male individually age-matched people. All patients had a positive RT-PCR test and a positive chest CT for COVID-19. The outcome was death within 28 days of admission, and the predictors were clinical features recorded at patients' bedsides.

Results

There was a significantly higher prevalence for asthma (p = 0.026) and pulmonary disease other than asthma (p < 0.001) in patients with the exposure. Sulfur mustard exposure was associated with increased risk for mortality of COVID-19 [hazard ratio (95% CI) = 1.92 (1.14,3.24), p = 0.013]. Early intubation signified a poor prognosis [hazard = 7.34 (4.65,11.58), p < 0.001]. However, individuals with higher PaO2 [hazard = 0.97 (0.95,0.98), p < 0.001], or people undergoing O2 therapy early upon admission [hazard = 0.58 (0.38,0.89), p = 0.011] showed lower risks for mortality. Individuals with asthma were at higher risk for mortality [hazard = 3.76 (1.69,8.36), p = 0.001].

Conclusion

Individuals with COVID-19 infection and sulfur mustard exposure should be considered high-risk patients and that, healthcare settings should be ready to provide critical care for them, including O2 therapy. They are more likely to have asthma or other pulmonary diseases.

Keywords

Sulfur mustard
COVID-19
Pulmonary
Asthma
Mortality
Risk

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