Celiac Disease Appears to Double COVID-19 Hospitalization Risk

Patients with celiac disease who have COVID-19 are twice as likely to be hospitalized as are individuals without the autoimmune condition, a single-center US study shows.

However, vaccination against COVID-19 reduced the risk for hospitalization by almost half for both groups, the study finds.

"To our knowledge this is the first study that demonstrated a vaccination effect on mitigation of the risk of hospitalization in celiac disease patients with COVID-19 infection," write Alberto Rubio-Tapia, MD, director, Celiac Disease Program, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Ohio, and colleagues.

Despite the increased risk for hospitalization among patients with celiac disease, there were no significant differences between those with and without the condition with respect to intensive care unit requirement, mortality, or thrombosis, the researchers find.

The findings suggest that celiac disease patients with COVID-19 are "not inherently at greater risk for more severe outcomes," they write.

The study was published online in Clinical Gastroenterology and Hepatology.

Comparing Outcomes

Although it has been shown that patients with celiac disease have increased susceptibility to viral illnesses, research to date has found similar COVID-19 incidence and outcomes, including hospitalization, between patients with celiac disease and the general population, the researchers write.

However, the impact of COVID-19 vaccination is less clear, so the researchers set out to compare the frequency of COVID-19–related outcomes between patients with and without celiac disease before and after vaccination.

Through an analysis of patient medical records, researchers found 171,763 patients diagnosed and treated for COVID-19 at their institution between March 1, 2020, and January 1, 2022. Of them, 110 adults had biopsy-proven celiac disease.

The median time from biopsy diagnosis of celiac disease to COVID-19 was 217 months, 66.3% of patients were documented to be following a gluten-free diet, and tissue transglutaminase IgA was positive in 46.2% at the time of COVID-19.

The celiac group was matched by age, ethnicity, sex, and date of COVID-19 diagnosis with a control group of 220 adults without a clinical diagnosis of celiac disease. The two cohorts had similar rates of comorbid obesity, type 2 diabetes, preexisting lung disease, and tobacco use.

Patients with celiac disease were significantly more likely to be hospitalized for COVID-19 than were the control participants, at 24% vs 11% (hazard ratio [HR], 2.1; P = .009), the researchers write.

However, hospitalized patients with celiac disease were less likely to require supplementary oxygen than were the control participants, at 63% vs 84%.

Vaccination rates for COVID-19 were similar between the two groups, at 64.5% among patients with celiac disease and 70% in the control group. Vaccination was associated with a lower risk for hospitalization on multivariate analysis. (HR, 0.53; P = .026).

There was no significant difference in hospitalization rates between vaccinated patients with celiac disease and vaccinated patients in the control group (odds ratio, 1.12; P = .79), the team reports.

The secondary outcomes of ICU requirement, mortality, and thrombosis were minimal in both groups, the researchers write.

Vaccination's Importance

The different findings regarding hospitalization risk among patients with celiac disease between this study and previous research are likely due to earlier studies not accounting for vaccination status, the researchers write.

"This study shows significantly different rates of hospitalization among patients with [celiac disease] depending on their vaccination status with strong evidence for mitigation of hospitalization risk through vaccination," they add.

"Vaccination against COVID-19 should be strongly recommended in patients with celiac disease," the researchers conclude.

No funding declared. Rubio-Tapia reports a relationship with Takeda. No other financial relationships declared.

Clin Gastroenterol Hepatol. Published online February 16, 2023. Source

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