Alcohol consumption and COVID-19 severity: a propensity score matched study in China

Objectives: To explore the relationship between alcohol consumption and COVID-19 severity of illness and hospital death.

Methods: This study included 1,087 COVID-19 patients confirmed by laboratory tests in many hospitals in Sichuan Province and Hubei Province during the COVID-19 epidemic. The patients were divided into a drinking group and a nondrinking group. For better baseline feature comparability between the two groups, we used propensity score matching (PSM) to generate a new cohort with a ratio of 1 : 2 (drinking group, n = 167; nondrinking group, n = 334) to compare the clinical symptoms, complications, complications, ICU admission and in-hospital death between the drinking group and the nondrinking group and to analyze the factors affecting ICU admission and the prognosis of in-hospital mortality of COVID-19 patients.

Results: The incidence of wheezing symptoms in the nondrinking group was higher than that in the drinking group (11.2% vs. 6.6%, P = 0.044) after PSM (12.3% vs. 6.6%, P = 0.032), and there was no difference in the incidence of other symptoms between the two groups. The incidence of stroke was lower in the drinking group than in the nondrinking group (0.0% vs. 2.4%, P = 0.025) after PSM (0.0% vs. 2.7%, P = 0.025). The multivariate analysis showed that drinking was not associated with ICU admission (OR = 1.240, 95% CI 0.322-4.772, P = 0.755) or in-hospital mortality outcomes (OR = 2.582, 95% CI 0.689-9.670, P = 0.159).

Conclusions: Drinking is not associated with patient ICU admission or hospital mortality. However, COVID-19 patients who drink alcohol have fewer wheezing symptoms and fewer stroke complications.

Coronavirus disease 2019; Drinking; ICU admission; Wheezing; Stroke; Hospital mortality

[1] Zhou P, Yang X, Wang X, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579: 270-273.

[2] Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - the latest 2019 novel coronavirus outbreak in Wuhan, China. International Journal of Infectious Diseases. 2020; 91: 264-266.

[3] World Health Organization. Weekly epidemiological update - 3 November 2020. 2020. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update---3- november-2020.

[4] Zhou Y, He Y, Yang H, Yu H, Wang T, Chen Z, et al. Exploiting an early warning Nomogram for predicting the risk of ICU admission in patients with COVID-19: a multi-center study in China. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020; 28: 106.

[5] Machhi J, Herskovitz J, Senan AM, Dutta D, Nath B, Oleynikov MD, et al. The natural history, pathobiology, and clinical manifestations of SARS-CoV-2 infections. Journal of Neuroimmune Pharmacology. 2020; 15: 359-386.

[6] Van Damme W, Dahake R, Delamou A, Ingelbeen B, Wouters E, Vanham G, et al. The COVID-19 pandemic: diverse contexts; different epidemics-how and why? BMJ Global Health. 2020; 5: e003098.

[7] Rajapakse N, Dixit D. Human and novel coronavirus infections in children: a review. Paediatrics and International Child Health. 2020; 1-20.

[8] Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nature Reviews Cardiology. 2020; 17: 543-558.

[9] Sockrider M, Tal-Singer R. Managing your chronic lung disease during the COVID-19 pandemic. American Journal of Respiratory and Critical Care Medicine. 2020; 202: P5-P6.

[10] Chick J. Alcohol and COVID-19. Alcohol and Alcoholism. 2020; 55: 341- 342.

[11] Angel-Korman A, Brosh T, Glick K, Leiba A. Covid-19, the kidney and hypertension. Harefuah. 2020; 159: 231-234. (In Hebrew)

[12] Harris B, McAlister A, Willoughby T, Sivaraman V. Alcohol-dependent pulmonary inflammation: a role for HMGB-1. Alcohol. 2019; 80: 45-52.

[13] Szabo G, Saha B. Alcohol’s effect on host defense. Alcohol Research: Current Reviews. 2015; 37: 159-170.

[14] Rehm J, Roerecke M. Cardiovascular effects of alcohol consumption. Trends in Cardiovascular Medicine. 2017; 27: 534-538.

[15] Campollo O. Alcohol and the liver: the return of the prodigal son. Annals of Hepatology. 2019; 18: 6-10.

[16] Krenz M, Korthuis RJ. Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms. Journal of Molecular and Cellular Cardiology. 2012; 52: 93-104.

[17] Zhang C, Qin Y, Chen Q, Jiang H, Chen X, Xu C, et al. Alcohol intake and risk of stroke: a dose-response meta-analysis of prospective studies. International Journal of Cardiology. 2014; 174: 669-677.

[18] Japanese Society of Nephrology. Essential points from evidence-based clinical practice guidelines for chronic kidney disease 2018. Clinical and Experimental Nephrology. 2019; 23: 1-15.

[19] Chung W, Promrat K, Wands J. Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases. World Journal of Hepatology. 2020; 12: 533-557.

[20] Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, et al. The Japanese clinical practice guideline for acute kidney injury 2016. Clinical and Experimental Nephrology. 2018; 22: 985-1045.

[21] Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. Journal of the American Medical Association. 2018; 319: 698.

[22] Vellas C, Delobel P, De Souto Barreto P, Izopet J. COVID-19, virology and geroscience: a perspective. The Journal of Nutrition, Health & Aging. 2020; 24: 685-691.

[23] Li H, Liu SM, Yu XH, Tang SL, Tang CK. Coronavirus disease 2019 (COVID-19): current status and future perspectives. International Journal of Antimicrobial Agents. 2020; 55: 105951.

[24] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Journal of the American Medical Association. 2020; 323: 1061.

[25] Gonzales K, Roeber J, Kanny D, Tran A, Saiki C, Johnson H, et al. Alcohol-attributable deaths and years of potential life lost-11 States, 2006-2010. Morbidity and Mortality Weekly Report. 2014; 63: 213-216.

[26] Goel S, Sharma A, Garg A. Effect of Alcohol Consumption on Cardiovascular Health. Current Cardiology Reports. 2018; 20: 19.

[27] Matsushita S, Higuchi S. Alcohol and the risk of dementia. Brain and Nerves. 2016; 68: 819-827. (In Japanese)

[28] Kodali S, Kaif M, Tariq R, Singal AK. Alcohol relapse after liver transplantation for alcoholic cirrhosis-impact on liver graft and patient survival: a meta-analysis. Alcohol and Alcoholism. 2018; 53: 166-172.

[29] Gano A, Pautassi RM, Doremus Fitzwater TL, Deak T. Conditioned effects of ethanol on the immune system. Experimental Biology and Medicine. 2017; 242: 718-730.

[30] Sapkota M, Wyatt TA. Alcohol, aldehydes, adducts and airways. Biomolecules. 2015; 5: 2987-3008.

[31] Wyatt TA, Gentry-Nielsen MJ, Pavlik JA, Sisson JH. Desensitization of PKA-stimulated ciliary beat frequency in an ethanol-fed rat model of cigarette smoke exposure. Alcoholism, Clinical and Experimental Research. 2004; 28: 998-1004.

[32] Sisson JH. Alcohol and airways function in health and disease. Alcohol. 2007; 41: 293-307.

[33] Simou E, Leonardi-Bee J, Britton J. The effect of alcohol consumption on the risk of ARDS: a systematic review and meta-analysis. Chest. 2018; 154: 58-68.

[34] Zheng Q, Li Y, Zhang L, Yao Q, Zhang J, Li M, et al. Association between drinking and all-cause mortality in patients with ischemic stroke. Nan Fang Yi Ke Da Xue Xue Bao. 2019; 39: 422-427. (In Chinese)

[35] Chiumello D, Busana M, Coppola S, Romitti F, Formenti P, Bonifazi M, et al. Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study. Intensive Care Medicine. 2020; 46: 2187-2196.

[36] Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. International Journal of Antimicrobial Agents. 2020; 55: 105924.

[37] Plapp BV, Leidal KG, Murch BP, Green DW. Contribution of liver alcohol dehydrogenase to metabolism of alcohols in rats. Chemico-Biological Interactions. 2015; 234: 85-95.

[38] Teschke R. Alcoholic liver disease: alcohol metabolism, cascade of molecular mechanisms, cellular targets, and clinical aspects. Biomedicines. 2018; 6: 106.