Alcohol use disorder as a potential risk factor for COVID‐19 severity: A narrative review

• Published in: Alcoholism, clinical and experimental research Vol. 46; no. 11; pp. 1930 - 1943
• Main Authors: Forsyth, Christopher B., Voigt, Robin M., Swanson, Garth R., Bishehsari, Faraz, Shaikh, Maliha, Zhang, Lijuan, Engen, Phillip, Keshavarzian, Ali
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-11-2022
• Subjects: Alcohol use; alcohol use disorder; Alcoholism - epidemiology; Bronchopulmonary infection; Cardiovascular diseases; Chronic illnesses; Coronaviruses; COVID-19; Death; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2; Disease; Dysbacteriosis; dysbiosis; Ethanol; Humans; Immune response; Inflammasomes; Inflammation; Influenza; Kidney diseases; Leaky gut; Lung diseases; Male; NLRP3; Pneumonia; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; COVID-19; alcohol use disorder; NLRP3; Leaky gut; dysbiosis
• ISSN: 0145-6008; 1530-0277; 1530-0277
• DOI: 10.1111/acer.14936

In Dec. 2019‐January 2020, a pneumonia illness originating in Wuhan, China, designated as coronavirus disease 2019 (COVID‐19) was shown to be caused by a novel RNA coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). People with advanced age, male sex, and/or underlying health conditions (obesity, type 2 diabetes, cardiovascular disease, hypertension, chronic kidney disease, and chronic lung disease) are especially vulnerable to severe COVID‐19 symptoms and death. These risk factors impact the immune system and are also associated with poor health, chronic illness, and shortened longevity. However, a large percent of patients without these known risk factors also develops severe COVID‐19 disease that can result in death. Thus, there must exist risk factors that promote exaggerated inflammatory and immune response to the SARS‐CoV‐2 virus leading to death. One such risk factor may be alcohol misuse and alcohol use disorder because these can exacerbate viral lung infections like SARS, influenza, and pneumonia. Thus, it is highly plausible that alcohol misuse is a risk factor for either increased infection rate when individuals are exposed to SARS‐CoV‐2 virus and/or more severe COVID‐19 in infected patients. Alcohol use is a well‐known risk factor for lung diseases and ARDS in SARS patients. We propose that alcohol has three key pathogenic elements in common with other COVID‐19 severity risk factors: namely, inflammatory microbiota dysbiosis, leaky gut, and systemic activation of the NLRP3 inflammasome. We also propose that these three elements represent targets for therapy for severe COVID‐19.
The COVID‐19 pandemic beginning in 2020 is associated with more than 600 million documented cases and over 6 million deaths worldwide. Disease severity risk factors include old age, and diseases of the lung, cardiovascular, kidney and obesity. This review proposes chronic alcohol use disorder (AUD) as a risk factor for COVID‐19 severity with evidence for three common pathologic mechanisms with these established COVID‐19 risk factors that include microbiome dysbiosis, leaky gut and activation of the NLRP3 inflammasome driving systemic inflammation.