The intestinal microbiota predicts COVID-19 severity and fatality regardless of hospital feeding method

Abstract

SARS-CoV-2-positive patients exhibit gut and oral microbiome dysbiosis, which is associated with various aspects of COVID-19 disease (1–4). Here, we aim to identify gut and oral microbiome markers that predict COVID-19 severity in hospitalized patients, specifically severely ill patients compared to moderately ill ones. Moreover, we investigate whether hospital feeding (solid versus enteral), an important cofounder, influences the microbial composition of hospitalized COVID-19 patients. We used random forest classification machine learning models with interpretable secondary analyses. The gut, but not the oral microbiota, was a robust predictor of both COVID-19-related fatality and severity of hospitalized patients, with a higher predictive value than most clinical variables. In addition, perturbations of the gut microbiota due to enteral feeding did not associate with species that were predictive of COVID-19 severity. IMPORTANCE SARS-CoV-2 infection leads to wide-ranging, systemic symptoms with sometimes unpredictable morbidity and mortality. It is increasingly clear that the human microbiome plays an important role in how individuals respond to viral infections. Our study adds to important literature about the associations of gut microbiota and severe COVID-19 illness during the early phase of the pandemic before the availability of vaccines. Increased understanding of the interplay between microbiota and SARS-CoV-2 may lead to innovations in diagnostics, therapies, and clinical predictions.

Inhibition of SARS-CoV-2 infection byPorphyromonas gingivalisand the oral microbiome

“…Evidence continues to accrue supporting the essential role that the oral and human microbiome plays in health and disease, 3,4 including COVID-19. [5][6][7][8] A number of studies have attempted to establish an association between the oral and gastrointestinal microbiome with COVID-19 as well as other viral infection. 5,[8][9][10] For example, microbiome dysbiosis in both gut and mouth as result of an altered microbial composition was associated with a more severe COVID-19 infection.…”