Mortality Increased Among Hospitalized Patients with Cirrhosis Before and Following Different Waves of the COVID-19 Pandemic.
COVID-19
Cirrhosis
Hospitalization
Mortality
Readmission
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
received:
30
03
2023
accepted:
30
08
2023
medline:
10
11
2023
pubmed:
21
10
2023
entrez:
21
10
2023
Statut:
ppublish
Résumé
The Coronavirus disease 2019 (COVID-19) pandemic disrupted patient care and worsened the morbidity and mortality of some chronic diseases. The impact of the COVID-19 pandemic on hospitalizations and outcomes in patients with cirrhosis both before and during different time periods of the pandemic has not been evaluated. Describe characteristics of hospitalized patients with cirrhosis and evaluate inpatient mortality and 30-day readmission before and after the start of the COVID-19 pandemic. Retrospective single-center cohort study of all hospitalized patients with cirrhosis from 2018 to 2022. Time periods within the COVID-19 pandemic were defined using reference data from the World Health Organization and Centers for Disease Control. Adjusted odds ratios from logistic regression were used to assess differences between periods. 33,926 unique hospitalizations were identified. Most patients were over age 60 years across all time periods of the pandemic. More Hispanic patients were hospitalized during COVID-19 than before COVID-19. Medicare and Medicaid are utilized less frequently during COVID-19 than before COVID-19. After controlling for age and gender, inpatient mortality was significantly higher during all COVID-19 periods except Omicron compared to before COVID-19. The odds of experiencing a 30-day readmission were 1.2 times higher in the pre-vaccination period compared to the pre-COVID-19 period. Inpatient mortality among patients with cirrhosis has increased during the COVID-19 pandemic compared to before COVID-19. Although COVID-19 infection may have had a small direct pathologic effect on the natural history of cirrhotic liver disease, it is more likely that other factors are impacting this population.
Sections du résumé
BACKGROUND
The Coronavirus disease 2019 (COVID-19) pandemic disrupted patient care and worsened the morbidity and mortality of some chronic diseases. The impact of the COVID-19 pandemic on hospitalizations and outcomes in patients with cirrhosis both before and during different time periods of the pandemic has not been evaluated.
AIMS
Describe characteristics of hospitalized patients with cirrhosis and evaluate inpatient mortality and 30-day readmission before and after the start of the COVID-19 pandemic.
METHODS
Retrospective single-center cohort study of all hospitalized patients with cirrhosis from 2018 to 2022. Time periods within the COVID-19 pandemic were defined using reference data from the World Health Organization and Centers for Disease Control. Adjusted odds ratios from logistic regression were used to assess differences between periods.
RESULTS
33,926 unique hospitalizations were identified. Most patients were over age 60 years across all time periods of the pandemic. More Hispanic patients were hospitalized during COVID-19 than before COVID-19. Medicare and Medicaid are utilized less frequently during COVID-19 than before COVID-19. After controlling for age and gender, inpatient mortality was significantly higher during all COVID-19 periods except Omicron compared to before COVID-19. The odds of experiencing a 30-day readmission were 1.2 times higher in the pre-vaccination period compared to the pre-COVID-19 period.
CONCLUSION
Inpatient mortality among patients with cirrhosis has increased during the COVID-19 pandemic compared to before COVID-19. Although COVID-19 infection may have had a small direct pathologic effect on the natural history of cirrhotic liver disease, it is more likely that other factors are impacting this population.
Identifiants
pubmed: 37864739
doi: 10.1007/s10620-023-08105-x
pii: 10.1007/s10620-023-08105-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4381-4388Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Middleton P, Hsu C, Lythgoe MP. Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies. BMJ Open Gastroenterol. 2021;8:e000739.
doi: 10.1136/bmjgast-2021-000739
pubmed: 34675033
Murthy S, Gomersall CD, Fowler RA. Care for critically Ill patients with COVID-19. JAMA. 2020;323:1499–1500.
doi: 10.1001/jama.2020.3633
pubmed: 32159735
Dorjee K, Kim H, Bonomo E, Dolma R. Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: a comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients. PLoS ONE. 2020;15:e0243191.
doi: 10.1371/journal.pone.0243191
pubmed: 33284825
pmcid: 7721151
Li J, Liu D, Yan J, Tan Y. Reductions in liver cirrhosis hospitalizations during the COVID-19 pandemic. Hepatol Int. 2021;15:213–214.
doi: 10.1007/s12072-020-10127-w
pubmed: 33420952
Shaheen AA, Kong K, Ma C et al. Impact of the COVID-19 pandemic on hospitalizations for alcoholic hepatitis or cirrhosis in Alberta, Canada. Clin Gastroenterol Hepatol. 2022;20:e1170–e1179.
doi: 10.1016/j.cgh.2021.10.030
pubmed: 34715379
Gonzalez HC, Zhou Y, Nimri FM et al. Alcohol-related hepatitis admissions increased 50% in the first months of the COVID-19 pandemic in the USA. Liver Int. 2022;42:762–764.
doi: 10.1111/liv.15172
pubmed: 35094494
Mahmud N, Hubbard RA, Kaplan DE, Serper M. Declining cirrhosis hospitalizations in the wake of the COVID-19 pandemic: a national cohort study. Gastroenterology 2020;159:1134–1136.
doi: 10.1053/j.gastro.2020.05.005
pubmed: 32387493
Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease-what we know on 1st May 2020. Aliment Pharmacol Ther 2020;52:267–275.
doi: 10.1111/apt.15813
pubmed: 32402090
pmcid: 7272838
Guan WJ, Liang WH, Zhao Y et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.
doi: 10.1183/13993003.00547-2020
pubmed: 32217650
pmcid: 7098485
Moon AM, Curtis B, Mandrekar P et al. Alcohol-associated liver disease before and after COVID-19-an overview and call for ongoing investigation. Hepatol Commun. 2021;5:1616–1621.
doi: 10.1002/hep4.1747
pubmed: 34510833
pmcid: 8239751
Hirode G, Saab S, Wong RJ. Trends in the burden of chronic liver disease among hospitalized US adults. JAMA Netw Open. 2020;3:e201997.
doi: 10.1001/jamanetworkopen.2020.1997
pubmed: 32239220
pmcid: 7118516
The Nielsen Company. Rebalancing the ‘COVID-19 Effect’ on alcohol sales. Volume 2021, 2020.
Pollard MS, Tucker JS, Green HD Jr. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3:e2022942.
doi: 10.1001/jamanetworkopen.2020.22942
pubmed: 32990735
pmcid: 7525354
Weerakoon SM, Jetelina KK, Knell G. Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults. Am J Drug Alcohol Abuse. 2021;47:98–106.
doi: 10.1080/00952990.2020.1832508
pubmed: 33280423
Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. BMJ 2018;362:k2817.
doi: 10.1136/bmj.k2817
pubmed: 30021785
pmcid: 6050518
Deutsch-Link S, Jiang Y, Peery AF et al. Alcohol-associated liver disease mortality increased from 2017 to 2020 and accelerated during the COVID-19 pandemic. Clin Gastroenterol Hepatol 2022;20:2142–2144.
doi: 10.1016/j.cgh.2022.03.017
pubmed: 35314353
pmcid: 8933289
Bajaj JS, Garcia-Tsao G, Biggins SW et al. Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Gut 2021;70:531–536.
doi: 10.1136/gutjnl-2020-322118
pubmed: 32660964
Kim D, Adeniji N, Latt N et al. Predictors of outcomes of COVID-19 in patients with chronic liver disease: US multi-center study. Clin Gastroenterol Hepatol 2021;19:1469–1479.
doi: 10.1016/j.cgh.2020.09.027
pubmed: 32950749
Da BL, Im GY, Schiano TD. Coronavirus disease 2019 hangover: a rising tide of alcohol use disorder and alcohol-associated liver disease. Hepatology 2020;72:1102–1108.
doi: 10.1002/hep.31307
pubmed: 32369624
Cooper S, Tobar A, Konen O et al. Long COVID-19 liver manifestation in children. J Pediatr Gastroenterol Nutr 2022;75:244–251.
doi: 10.1097/MPG.0000000000003521
pubmed: 35687535
Milic J, Barbieri S, Gozzi L et al. Metabolic-associated fatty liver disease is highly prevalent in the postacute COVID syndrome. Open Forum Infect Dis 2022;9:ofac003.
doi: 10.1093/ofid/ofac003
pubmed: 35146047
pmcid: 8826155
Vergara M, Cleries M, Vela E et al. Hospital mortality over time in patients with specific complications of cirrhosis. Liver Int 2013;33:828–833.
doi: 10.1111/liv.12137
pubmed: 23496284
Ioannou GN, Liang PS, Locke E et al. Cirrhosis and severe acute respiratory syndrome coronavirus 2 infection in US veterans: risk of infection, hospitalization, ventilation, and mortality. Hepatology 2021;74:322–335.
doi: 10.1002/hep.31649
pubmed: 33219546
Moon AM, Webb GJ, Aloman C et al. High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: preliminary results from an international registry. J Hepatol 2020;73:705–708.
doi: 10.1016/j.jhep.2020.05.013
pubmed: 32446714
pmcid: 7241346
Chakrabarti A, Osborne NH, Rangnekar AS et al. The effect of hospital characteristics on racial/ethnic variation in cirrhosis mortality. J. Racial Ethnic Health Disparities 2017;4:243–251.
doi: 10.1007/s40615-016-0223-2
Nanchal R, Patel D, Guddati AK et al. Outcomes of Covid 19 patients-are hispanics at greater risk? J Med Virol 2022;94:945–950.
doi: 10.1002/jmv.27384
pubmed: 34633096
Longcoy J, Patwari R, Hasler S et al. Racial and ethnic differences in hospital admissions of emergency department COVID-19 patients. Med Care 2022;60:415–422.
doi: 10.1097/MLR.0000000000001710
pubmed: 35315379
pmcid: 9093229
Jacobson M, Chang TY, Shah M et al. Racial and ethnic disparities in SARS-COV-2 testing and COVID-19 outcomes in a medicaid managed care cohort. AJPM 2021;61:644–651.
Arvaniti V, D’Amico G, Fede G et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139:1246–1256.
doi: 10.1053/j.gastro.2010.06.019
pubmed: 20558165
Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014;61:1385–1396.
doi: 10.1016/j.jhep.2014.08.010
pubmed: 25135860
Griffith DM, Sharma G, Holliday CS et al. Men and COVID-19: a biopsychosocial approach to understanding sex differences in mortality and recommendations for practice and policy interventions. Prev Chronic Dis 2020;17:200247.
doi: 10.5888/pcd17.200247
Nair R, Lak H, Hasan S et al. Reducing all-cause 30-day hospital readmissions for patients presenting with acute heart failure exacerbations: a quality improvement initiative. Cureus 2020;12:e7420.
pubmed: 32351805
pmcid: 7186095
Ziaeian B, Fonarow GC. The prevention of hospital readmissions in heart failure. Prog Cardiovasc Dis 2016;58:379–385.
doi: 10.1016/j.pcad.2015.09.004
pubmed: 26432556
Garg SK, Goyal H, Obaitan I et al. Incidence and predictors of 30-day hospital readmissions for liver cirrhosis: insights from the United States National Readmissions Database. Ann Transl Med 2021;9:1052.
doi: 10.21037/atm-20-1762
pubmed: 34422964
pmcid: 8339830