Alterations to the saliva microbiome based on SARS-CoV-2 viral load indicate potential biologically relevant bacterial-viral relationships which may affect clinical outcomes in COVID-19 disease.

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Background & Aims Celiac disease is a common disorder with a worldwide distribution, though the prevalence among different ethnicities varies. We aimed to measure the prevalence of duodenal villous atrophy among patients of different ethnicities throughout the United States (US). Methods We performed a cross-sectional study of all patients who had duodenal biopsies submitted to a national pathology laboratory between January 2, 2008 and April 30, 2015. The prevalence of villous atrophy was calculated for the following ethnicities, using a previously published algorithm based on patient names: North Indian, South Indian, East Asian, Hispanic, Middle Eastern, Jewish, and other Americans. Results Among all patients (n=454,885), the median age was 53 years and 66% were female. The overall prevalence of celiac disease was 1.74%. Compared to other Americans (n=380,163; celiac disease prevalence 1.83%), celiac disease prevalence was lower in patients of South Indian (n=177, 0%; P=.08), East Asian (n=4700, 0.15%; P=<.0001), and Hispanic (n=31,491, 1.06%; P=<.0001) ethnicities. Celiac disease was more common in patients from the Punjab region (n=617, 3.08%) than in others from North India (n=1195, 1.51%; P=.02). The prevalence of celiac disease among patients of Jewish (n=17,806, 1.80%; P=.78) and Middle Eastern (n=1903, 1.52%; P=.33) ethnicities was similar to that of other Americans. Among Jewish individuals (n=17,806), the prevalence of celiac disease was 1.83% in Ashkenazi persons (n=16,440) and 1.39% in Sephardic persons (n=1366; P=.24). Conclusions Among patients undergoing duodenal biopsy, individuals from the Punjab region of India constitute the ethnic group in the US with the highest prevalence of villous atrophy consistent with celiac disease. Compared to other Americans, villous atrophy prevalence on duodenal biopsy is significantly lower among US residents of South Indian, East Asian, and Hispanic ancestry.

Objective To examine the impact of autoimmune disease on the composite outcome of intensive care unit admission, intubation, or death, from COVID-19 in hospitalized patients. Methods Retrospective cohort study of 186 patients hospitalized with COVID-19 between March 1st–April 15th, 2020 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center. The cohort included 62 patients with autoimmune disease and 124 age- and sex-matched controls. The primary outcome was a composite of intensive care unit admission, intubation, and death, with secondary outcome assessing time to in-hospital death. Baseline demographics, comorbidities, medications, vital signs, and laboratory values were collected. Conditional logistic regression and Cox proportional hazards regression were used to assess the association between autoimmune disease and clinical outcomes. Results Patients with autoimmune disease were more likely to have at least one comorbidity (25.8% vs. 12.9%, p=0.03), take chronic immunosuppressive medications (66.1% vs. 4.0%, p<0.01), and have had a solid organ transplant (16.1% vs. 1.6%, p<0.01). There were no significant differences in intensive care unit admission (14.2% vs. 19.4%, p=0.44), intubation (14.2% vs. 17.7%, p=0.62) or death (17.5% vs. 14.5%, p=0.77). On multivariable analysis, patients with autoimmune disease were not at an increased risk for a composite outcome of intensive care unit admission, intubation, or death (adjOR 0.79, 95%CI 0.37-1.67). On Cox regression, autoimmune disease was not associated with in-hospital mortality (adjHR 0.73, 95%CI 0.33-1.63). Conclusion Among patients hospitalized with COVID-19, individuals with autoimmune disease did not have an increased risk of a composite outcome of intensive care unit admission, intubation, or death.

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