Increased Risk of Hospitalization in Celiac Disease With COVID-19 Infection Is Mitigated by Vaccination

Clin Gastroenterol Hepatol. 2023 Jun;21(6):1485-1492. doi: 10.1016/j.cgh.2023.01.029. Epub 2023 Feb 16.


Background: We sought to describe clinical characteristics of celiac disease (CD) patients infected with coronavirus disease 2019 (COVID-19) and estimate hospitalization risk, intensive care unit (ICU) requirement, mortality, and thrombosis, and the impact of vaccination on these outcomes.

Methods: We performed a single-center, retrospective cohort study comparing biopsy-proven CD patients with a matched sample of non-CD (referent) patients diagnosed with COVID-19 between March 2020 and January 2022. Matching ensured 2 referent patients for every 1 CD patient by age, sex, ethnicity, and COVID-19 diagnosis date. We also adjusted for general and celiac-specific comorbidity. The primary outcome was hospitalization. Secondary outcomes included ICU requirement, mortality, and thrombosis. We also compared these outcomes between vaccinated and unvaccinated individuals.

Results: We included 330 patients: 110 with CD (mean age 47 years, 83% female) and 220 matched referents. Hospitalization occurred in 27 CD patients (24%) and 25 referent patients (11%) (hazard ratio, 2.10; 95% confidence interval, 1.21-3.65; P = .009). Vaccination was associated with significantly decreased risk of hospitalization (hazard ratio, 0.53; 95% confidence interval, 0.31-0.93; P = .026). Four unvaccinated CD patients and 2 unvaccinated referent patients required ICU. No mortality occurred among CD patients, and 2 referent patients died. No thrombosis occurred in either group.

Conclusions: CD patients with COVID-19 have a higher risk of hospitalization compared with non-CD referents. This risk is mitigated by vaccination in CD patients as it is in non-CD referents. ICU requirement occurred only in unvaccinated CD patients, and no CD patient died. Vaccination against COVID-19 should be strongly recommended in patients with CD as it is for non-CD patients in the general population.

Keywords: COVID; Coronavirus; Enteropathy; Immunization; Pandemic; Vaccine.

MeSH terms

  • COVID-19 Testing
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Celiac Disease* / complications
  • Celiac Disease* / epidemiology
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Vaccination