Hematological and Biochemical Parameters Associated with Mortality in COVID-19 Infection and Their Correlation with Smoking

Document Type : Original Article


1 Department of Nursing and Midwifery, Faculty of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran.

2 Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Nuclear Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

4 Kidney Transplantation and Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Medical Genetics Research Center, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. and Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

7 Department of Nursing and Midwifery, Faculty of Nursing, Islamic Azad University of Mashhad, Mashhad, Iran.

8 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Coronavirus disease 2019 (COVID-19) initially appeared in China, in December 2019 and has already evolved into a pandemic spreading rapidly throughout the world. The present study aimed to determine the relationship between hematologic and biochemical parameters associated with the mortality rate in COVID-19 infection and their correlation with smoking.
Materials and Methods:
This study was performed on 388 patients affected by COVID-19 who were admitted to Imam Reza Hospital in Mashhad, Iran from February 20, 2020, to May 21, 2020.
The patients were within the age range of 18-94 years old, and 341 of them were nonsmokers, while 47 of them were smokers. Moreover, chronic obstructive pulmonary diseases were more frequent among smokers. The mean of initial (on admission) white blood cell (WBC) count in smokers was significantly higher than nonsmokers (P=0.015). Males were more prone to death due to COVID-19 infection than females (P=0.035). In total, 60 (15.46%) out of 388 patients died because of COVID-19, while 84.5% of them survived.
The results indicated a higher WBC count among smokers. Moreover, a higher WBC count on admission was associated with higher mortality. However, hospitalization duration was not different among smokers and nonsmokers groups. It was found that higher CRP levels and hospitalization periods were associated with an increased risk of death. The COVID-19 mortality rate was higher in men, compared to women. Eventually, no significant correlation was found between smoking and the mortality of patients with COVID-19.


  1. Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tobacco induced diseases. 2020;18.
  2. Abdi M. Coronavirus disease 2019 (COVID-19) outbreak in Iran: Actions and problems. Infection Control & Hospital Epidemiology. 2020;41(6):754-5.
  3. Dong E, Du H, Gardner L. An interactive webbased dashboard to track COVID-19 in real time. The Lancet infectious diseases. 2020; 20(5): 533-4.
  4. Boulos MNK, Geraghty EM. Geographical tracking and mapping of coronavirus disease COVID-19/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic and associated events around the world: how 21st century GIS technologies are supporting the global fight against outbreaks and epidemics. BioMed Central; 2020.
  5. Organization WH. Health Topics. Coronavírus. Coronavirus: symptoms World Health Organization, 2020a Disponível em: https: //www who int/healthtopics/ coronavirus# tab= tab_3 Acesso em. 2020;7. 6. Control CfD, Prevention. National center for immunization and respiratory diseases (NCIRD). Influenza vaccination coverage https:// www cdc gov/flu/ fluvaxview/trends/adults-over18 htm. 2012.
  6. Gao B-J, Luo J, Liu Y, Zhong F-R, Guo Q-X, Peng F-Y, et al. Solid pseudopapillary neoplasm (SPN) of the pancreas presenting with ascites misdiagnosed as pancreatic tuberculosis: a case report and literature review. International Journal of Clinical and Experimental Pathology. 2020;13(2):248.
  7. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, AlRabiah FA, Al-Hajjar S, Al-Barrak A, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. The Lancet infectious diseases. 2013;13(9):752-61. Sobhani S, et al Prognostic Markers of Covid-19 and the Correlation with Smoking 46 PSQI J, Vol. 9, No. 1, Win 2021
  8. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID19) outbreak. Journal of autoimmunity. 2020: 102433.
  9. Wang J, Luo Q, Chen R, Chen T, Li J. Susceptibility analysis of COVID-19 in smokers based on ACE2. 2020.
  10. Moosazadeh M, Ziaaddini H, Mirzazadeh A, Ashrafi-Asgarabad A, Haghdoost AAJA, health. Meta-analysis of smoking prevalence in Iran. 2013; 5(3-4):140.

12.Hum IMECR, Humans IWGotEoCRt. Tobacco smoke and involuntary smoking. 2004.

  1. Zhou Z, Chen P, Peng H. Are healthy smokers really healthy? Tobacco induced diseases. 2016; 14(1):35.
  2. Tonnesen P, Marott JL, Nordestgaard B, Bojesen SE, Lange P. Secular trends in smoking in relation to prevalent and incident smokingrelated disease: A prospective population-based study. Tobacco induced diseases. 2019;17.
  3. Arcavi L, Benowitz NL. Cigarette smoking and infection. Archives of internal medicine. 2004; 164 (20):2206-16.
  4. Park J-E, Jung S, Kim A. MERS transmission and risk factors: a systematic review. BMC Public Health. 2018;18(1):574.
  5. Cai H. Sex difference and smoking predisposition in patients with COVID-19. The Lancet Respiratory Medicine. 2020;8(4):e20.

18.Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical Infectious Diseases. 2020.

  1. Singhal T. A review of coronavirus disease2019 (COVID-19). The Indian Journal of Pediatrics. 2020:1-6.
  2. Shipa SA, Rana MM, Miah MF, Alam MJ, Mahmud MGR. Effect of Intensity of Cigarette Smoking on Leukocytes among Adult Men and Women Smokers in Bangladesh. Asia Pacific Journal of Medical Toxicology. 2017;6(1):12-7.
  3. Sunyer J, Mu¯ oz A, Peng Y, Margolick J, Chmiel JS, Oishi J, et al. Longitudinal relation between smoking and white blood cells. American journal of epidemiology. 1996;144(8):734-41.
  4. Stang P, Lydick E, Silberman C, Kempel A, Keating ET. The prevalence of COPD: using smoking rates to estimate disease frequency in the general population. Chest. 2000; 117(5): 354S-9S.
  5. Laniado-Laborín R. Smoking and chronic obstructive pulmonary disease (COPD). Parallel epidemics of the 21st century. International journal of environmental research and public health. 2009;6(1):209-24. 24.Kazancio─člu R. Risk factors for chronic kidney disease: an update. Kidney international supplements. 2013;3(4):368-71.

25.Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients—absence of evidence or evidence of absence? Clinical Journal of the American Society of Nephrology. 2008;3(1):226-36.