Introduction: The use of electronic cigarettes as a seemingly safer alternative to combustible tobacco has risen sharply in recent years. While primarily linked to worsening respiratory conditions, emerging data suggest broader systemic effects. Recent evidence shows that exposure impairs key neutrophil functions—chemotaxis, phagocytosis, and extracellular trap formation—heightening vulnerability to infections and their severity. Despite these concerns, regulatory oversight remains limited, underscoring the urgent need for comprehensive investigation into its uncertain impact. Methods: We conducted a retrospective analysis using data from the 2020–2022 National Inpatient Sample (NIS) database. Patients with sepsis and concurrent e-cigarette use were identified via validated ICD-10 codes. Multivariate logistic regression adjusted for confounders including sex, age, race, cigarette smoking, obesity, and comorbidity burden (Charlson and Elixhauser Indices). Statistical analyses were performed using STATA 18. Results: A total of 1, 435, 602 patients were admitted with a primary diagnosis of sepsis, of whom 14. 6% (n = 209, 203) had concurrent e-cigarette use. The mean age was 64 years in both groups. Females comprised 43. 8% of the e-cigarette user group. Patients with concurrent e-cigarette use had significantly worse in-hospital outcomes, including higher mortality (OR: 3. 68; 95% CI: 3. 58–3. 79; p < 0. 001), increased use of high-flow nasal cannula (OR: 7. 15; 95% CI: 6. 68–7. 66; p < 0. 001), non-invasive mechanical ventilation (OR: 2. 73; 95% CI: 2. 63–2. 84; p < 0. 001), invasive mechanical ventilation (OR: 2. 74; 95% CI: 2. 66–2. 83; p < 0. 001), and extracorporeal membrane oxygenation (OR: 4. 05; 95% CI: 3. 91–4. 20; p < 0. 001). They also experienced longer hospital stays (mean: 10. 93 vs. 7. 44 days; 95% CI: 3. 44–3. 53; p < 0. 001) and higher hospitalization costs (mean: 156, 007 vs. 97, 312; p < 0. 001). Conclusions: E-cigarette use is associated with more severe outcomes in patients with sepsis, including increased mortality, greater need for respiratory support, prolonged hospital stays, and higher healthcare costs. It should be recognized as a potential risk factor in the clinical management of sepsis, underscoring the need for further research into its mechanisms, adverse effects and targeted prevention strategies.
Ortega et al. (Sun,) studied this question.