Atrium Health, Carolinas Medical Center Charlotte, NC, United States
Natasha Adlakha, MD1, Steven Zacks, MD, MPH2, Mark Russo, MD, MPH, FACG3 1Atrium Health, Carolinas Medical Center, Charlotte, NC; 2University of North Carolina School of Medicine, Charlotte, NC; 3Atrium Health, Charlotte, NC
Introduction: Coronavirus disease 2019 (COVID-19) is an international public health crisis affecting medical care for many chronic disease populations, including those with cirrhosis. Routine care transformed to safely allow elective endoscopic procedures by obtaining a pre-endoscopy viral PCR nasal swab to minimize endoscopy staff exposure. Little data exists on the prevalence of asymptomatic cirrhotic COVID-19 positive patients or a comparison to the general community prevalence. We used pre-procedure testing data to estimate an asymptomatic prevalence in patients with cirrhosis.
Methods: This is a retrospective review of all patients with cirrhosis undergoing ambulatory endoscopy at two hospitals and two endoscopy centers at Atrium Health in Charlotte, NC from 4/1/2020 through 12/31/2020. Pre-procedure SARS-CoV-2 RT PCR nasal swab testing was a mandatory requirement during these months. The number of positive nasal swabs were recorded. Patient demographics, clinical and laboratory data, COVID-19 clinical course, 90 day follow up for hospitalizations, decompensation, and/or “long haul” COVID-19 complications were recorded. Publicly available data on all elective Atrium Health positive pre-procedure and statewide prevalence rates were also recorded for these dates.
Results: A total of 398 cirrhotic patients were scheduled for ambulatory endoscopy procedures with confirmed pre-procedure PCR testing, with 3 positive results (1.0%). All three developed mild symptoms and were automatically enrolled in Atrium Health virtual hospital observation for a minimum of 10 days, per protocol. Table 1 indicates clinical course and outcomes. During the same time period, the average daily positive rate of Atrium Health pre-procedure testing was 2.5% (range 0-11%). Available state data indicates the positive rate ranged from 5.4%-15.4%.
Discussion: This is the only known study evaluating the prevalence of asymptomatic cirrhotic COVID-19 patients for elective endoscopy. The prevalence in our cirrhosis population was much lower than the general patient pre-procedure positive rate and reported statewide community prevalence. The three positive cirrhosis patients in this study had a benign COVID-19 course. This data suggests that patients with compensated cirrhosis with asymptomatic SARS-CoV-2 infection may have a mild clinical course. It also indicates a very low prevalence of SARS-CoV-2 in cirrhotic patients presenting for outpatient elective endoscopy suggesting routine screening in this population is unnecessary.
Patient
Symptoms
Days in Virtual Hospital Observation Beyond Protocol
Number of hospitalizations at 30/60/90 days
Reason for hospitalization, days admitted
Oxygen Requirement
90 day cirrhosis decompensating events or COVID complications
1
Loss of taste, myalgias, sinus congestion
0
0/0/0
N/A
None
None
2
Loss of taste, fever
4, prolonged fever >101o F
1/0/0
COPD exacerbation, 4 days
None
None
3
Cough, shortness of breath
0
0/0/0
N/A
None
None
Table: Table 1 -PCR positive patients with cirrhosis COVID clinical course including 90 day follow up for hospitalizations, decompensating events or COVID related complications.
Disclosures:
Natasha Adlakha indicated no relevant financial relationships.
Steven Zacks indicated no relevant financial relationships.
Mark Russo indicated no relevant financial relationships.
Natasha Adlakha, MD1, Steven Zacks, MD, MPH2, Mark Russo, MD, MPH, FACG3. P1799 - Prevalence of COVID-19 in Patients With Cirrhosis Undergoing Outpatient Pre-Endoscopy Testing, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
