Characteristics and Outcomes of Patients Admitted for Acute Alcoholic Hepatitis Before and During the COVID-19 Pandemic
1Surgery, Michigan Medicine, Ann Arbor, MI, 2Internal Medicine, Michigan Medicine, Ann Arbor, MI, 3Internal Medicine, Northwestern Memorial Hospital, Chicago, IL
Meeting: 2022 American Transplant Congress
Abstract number: 1432
Keywords: Alcohol, COVID-19, Hepatitis, Outcome
Topic: Clinical Science » Liver » 53 - Liver: Cirrhosis - Portal Hypertension and Other Complications
Session Information
Session Name: Liver: Cirrhosis - Portal Hypertension and Other Complications
Session Type: Poster Abstract
Date: Monday, June 6, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Despite known increases in alcohol use, changes in alcohol-associated liver disease rates during COVID-19 have not been well characterized. We compared the incidence and outcomes of hospitalized patients with acute alcoholic hepatitis (AH) before and during COVID-19.
*Methods: We identified patients admitted with AH at two tertiary care centers by retrospective chart review in pre-COVID-19 (4/1-6/31/2019) and during COVID-19 (4/1-6/31/2020) time periods using strict criteria (total bilirubin>3.0, AST 35-500, ALT 49-500, and heavy drinking within 60 days of admission). Severe AH was defined as Maddrey’s discriminant function (MDF) ≥ 32. Univariable comparisons were performed using Chi-square and Wilcoxon rank sum tests as appropriate.
*Results: Inpatient admissions for AH increased from 0.13% (90 of 69610) pre-COVID-19 to 0.25% (160 of 63021) during COVID-19 (P<.001). During COVID-19, AH patients had lower rates of polysubstance abuse (40% vs 18%, P<.001) compared to pre-COVID-19 (Table 1). Mental health and substance abuse (MHSA) consult rate was 52% pre- and during COVID-19. Relapse medication use rate was 8% and did not differ significantly between time periods. In severe AH (N=127) frequency of steroid treatment (39% vs 48%, P=0.31), evaluation for (12% vs 16%, P=0.61) or receipt of liver transplant (2% vs 4%, P=1.00) were similar pre- and during COVID-19. Compared to pre-COVID-19, AH patients during COVID-19 had significantly lower rates of all-cause 90-day readmission (59% vs 42%, P=0.02), but there was no difference in rates of 90-day readmission for AH (27% vs 22%, P=0.47), inpatient mortality (11% vs 9%, P=0.66) and 12-month mortality (30% vs 23%, P=0.23).
*Conclusions: Inpatient admission rates for AH nearly doubled during COVID-19. Polysubstance abuse was less common among patients with AH during COVID-19, but 90-day readmission rates remained high pre- and during COVID-19. Low rates of both MHSA consult and relapse medication use indicate a need for greater attention to inpatient alcohol treatment.
| Pre-COVID-19 (N=90) |
During COVID-19 (N=160)
|
P | |
| Age, median (IQR) | 46 (36-53) | 46 (38-55) | 0.67 |
| Female, n (%) | 41 (46%) | 67 (42%) | 0.57 |
| Non-Hispanic White, n (%) | 68 (76%) | 116 (72%) | 0.21 |
| Polysubstance abuse, n (%) | 35 (40%) | 28 (18%) | <.001 |
| Pre-existing cirrhosis, n (%) | 56 (62%) | 99 (62%) | 0.96 |
| MDF, median (IQR) | 36 (21-57) | 30 (18-60) | 0.53 |
To cite this abstract in AMA style:
Anderson MS, Uttal S, Bertha M, Jencks K, Asefah H, Gustafson A, Truitt KN, Maddur P, Mellinger J. Characteristics and Outcomes of Patients Admitted for Acute Alcoholic Hepatitis Before and During the COVID-19 Pandemic [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/characteristics-and-outcomes-of-patients-admitted-for-acute-alcoholic-hepatitis-before-and-during-the-covid-19-pandemic/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress