BACKGROUND
COVID-19 has affected every country globally, with hundreds of millions of people infected with the SARS-CoV-2 virus and over 6 million deaths to date. It is unknown how alcohol use disorder (AUD) may affect the severity and mortality of COVID-19. AUDs are known to increase the severity and mortality of bacterial pneumonia and the risk of developing acute respiratory distress syndrome (ARDS). Our objective is to determine whether those with AUDs have increased severity and mortality from COVID-19.

METHODS
We utilized a retrospective cohort study of inpatients and outpatients from 44 centers participating in the National COVID Cohort Collaborative (N3C). All were adult COVID-19 patients with and without documented AUDs RESULTS: We identified 25,583 COVID-19 patients with AUDs and 1,309,445 without. In unadjusted comparisons, those with AUD had higher odds of hospitalization (odds ratio [OR] 2.00, 95% confidence interval [CI]1.94-2.06, p<0.001). After adjusting for age, sex, race/ethnicity, smoking, BMI, and comorbidities, those with an AUD still had higher odds of requiring hospitalization (adjusted OR [aOR] 1.51, CI 1.46-1.56, p<0.001). In unadjusted comparisons, those with AUD had higher odds of all-cause mortality (OR 2.18, CI 2.05-2.31, p<0.001) After adjusting as above, those with an AUD still had higher odds of all-cause mortality (aOR 1.55, CI 1.46-1.65, p<0.001).

CONCLUSION
This work suggests that AUDs can increase the severity and mortality of COVID-19 infection. This reinforces that clinicians should obtain an accurate alcohol history from patients admitted with COVID-19. For this study, our results are limited by our inability to quantify the daily drinking habits of the participants. Further studies are needed to determine the mechanisms of how AUDs increase the severity and mortality of COVID-19.