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We aimed to rigorously and definitively quantify the effects of smoking on COVID\u201019 severity. MEDLINE, Embase, CENTRAL, and Web of Science were searched between 1 December 2019 and 2 June 2020. Studies reporting smoking status of hospitalized patients with different severities of disease and\/or at least one clinical endpoint of interest (disease progression, intensive care unit admission, need for mechanical ventilation, and mortality) were included. Data were pooled using a random\u2010effects model. This study was registered on PROSPERO: CRD42020180920. We analyzed 47 eligible studies reporting on 32\u2009849 hospitalized COVID\u201019 patients, with 8417 (25.6%) reporting a smoking history, comprising 1501 current smokers, 5676 former smokers, and 1240 unspecified smokers. Current smokers had an increased risk of severe COVID\u201019 (risk ratios [RR]: 1.80; 95% confidence interval [CI]: 1.14\u20102.85; <jats:italic>P<\/jats:italic>\u2009=\u2009.012), and severe or critical COVID\u201019 (RR: 1.98; CI: 1.16\u20103.38; <jats:italic>P<\/jats:italic>\u2009=\u2009.012). Patients with a smoking history had a significantly increased risk of severe COVID\u201019 (RR: 1.31; CI: 1.12\u20101.54; <jats:italic>P<\/jats:italic>\u2009=\u2009.001), severe or critical COVID\u201019 (RR: 1.35; CI: 1.19\u20101.53; <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001), in\u2010hospital mortality (RR: 1.26; CI: 1.20\u20101.32; <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001), disease progression (RR: 2.18; CI: 1.06\u20104.49; <jats:italic>P<\/jats:italic>\u2009=\u2009.035), and need for mechanical ventilation (RR: 1.20; CI: 1.01\u20101.42; <jats:italic>P<\/jats:italic>\u2009=\u2009.043). Patients with any smoking history are vulnerable to severe COVID\u201019 and worse in\u2010hospital outcomes. In the absence of current targeted therapies, preventative, and supportive strategies to reduce morbidity and mortality in current and former smokers are crucial.<\/jats:p>","DOI":"10.1002\/jmv.26389","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T15:02:58Z","timestamp":1596553378000},"page":"1045-1056","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":343,"title":["The effect of smoking on COVID\u201019 severity: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4726-157X","authenticated-orcid":false,"given":"Rohin K.","family":"Reddy","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walton N.","family":"Charles","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Sklavounos","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Dutt","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul T.","family":"Seed","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur","family":"Khajuria","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London London UK"},{"name":"Kellogg College University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,13]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"WHO.Coronavirus disease (COVID\u201019) Situation Report \u2010 190. 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