Introduction: Alcohol related liver disease (ALD) is associated with high mortality, accounting for 48% of cirrhosis-related deaths in the US. Studies show excessive alcohol intake has increased by 21% in the US since the COVID pandemic. Our study aims to compare pre-COVID to pandemic hospitalization and mortality rates to assess the burden of COVID on ALD.
Methods: This was a retrospective, IRB approved, study of patients admitted for ALD from January 2019-December 2021. ALD included diagnosis of alcohol cirrhosis, alcohol hepatitis, alcohol fatty liver disease, and acute on chronic liver failure due to alcohol. Pre-COVID admissions ranged January 2019-February 2020 and pandemic ranged March 2020-December 2021. The 30-day mortality was defined as patient death date 30 days or less from admission. The change in ALD admissions through time was analyzed with a local polynomial regression smoothing function plot comparing the average number of monthly pre-COVID ALD admissions to each monthly number of pandemic ALD admissions, and the differences were compared using t-test. Univariate and multivariate analysis with Cox proportional hazards regression model was performed. Pre-COVID and pandemic 30-day mortality rates were compared with Kaplan-Meier survival curve, using a 95% confidence interval. R (version 3.6.2; Vienna, Austria) was used for analyses and p-value< 0.05 was considered statistically significant.
Results: Among 688 ALD admissions, 249 were pre-COVID and 439 were pandemic. Pre-COVID and pandemic patients were similar with males (62% vs 61%), average age (56 vs 55), prior diagnosis of cirrhosis (37% vs 33%, p=0.41) and/or alcohol hepatitis (70% vs 65%, p=0.29), respectively. The average number of monthly ALD admissions pre-COVID was 18. During the pandemic, the number of monthly ALD admissions increased to 23 (range 20-26) after restrictions were first enforced, from May-September 2020, then again increased to 26 (range 20-35) after Omicron restrictions were re-enforced, from December 2020-August 2021 (Table 1). The 30-day mortality rate between pre-COVID and the pandemic was not significantly different by univariate (HR 1.21, CI 0.67-1.88, p=0.67) or multivariate analysis (HR 1.54, CI 0.90-2.64, p=0.11) (Figure 1).
Discussion: This study demonstrates a significant increase in the number of ALD admissions during the pandemic, particularly following enforcement of public health restrictions. Despite this increase, the 30-day mortality rate has not been impacted.
