Background Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19. Objective We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk. Methods In this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status. Results Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95% CI 1.17-3.06), suggesting that UAU was associated with an 89% increase in the odds of being in a higher severity category. Conclusions In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death.
【저자키워드】 COVID-19, SARS-CoV-2, acute respiratory distress syndrome, mechanical ventilation, Substance use, unhealthy alcohol use, substance misuse, 【초록키워드】 Pneumonia, knowledge, cross-sectional, severity, disease severity, hospital, Cancer, COVID-19 severity, Sex, risk, cardiovascular disease, diabetes, classification, outcome, smoking, alcohol, Probability, Nasopharyngeal swab, Health, Sensitivity and specificity, severity of COVID-19, Patient, Model, death, age, BMI, smoking status, Admission, Care, severe COVID-19 disease, immune mechanism, acute respiratory distress, Odds ratio, severe disease, Classifier, ventilator, 95% CI, syndrome, Cutoff, independent risk factor, positive, revision, Effect, objective, ICD-10, multivariable, Result, greater, tested, predicted, identify, performed, develop, adjusted, determine, increase in, modify, disrupt, infected with SARS-CoV-2, patients with COVID-19, took place, 【제목키워드】 Factor, Increased,