Characteristics and Outcomes of Patients Admitted for Acute Alcoholic Hepatitis Before and During the COVID-19 Pandemic

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. Method(s): 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. Result(s): 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). Conclusion(s): 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. (Table Presented).

A Risk Score to Predict Admission to the Intensive Care Unit in Patients with COVID-19: the ABC-GOALS score.

OBJECTIVE: To develop a score to predict the need for ICU admission in COVID-19. METHODS: We assessed patients admitted to a COVID-19 center in Mexico. Patients were segregated into a group that required ICU admission, and a group that never required ICU admission. By logistic regression, we derived predictive models including clinical, laboratory, and imaging findings. The ABC-GOALS was constructed and compared to other scores. RESULTS: We included 329 and 240 patients in the development and validation cohorts, respectively. One-hundred-fifteen patients from each cohort required ICU admission. The clinical (ABC-GOALSc), clinical+laboratory (ABC-GOALScl), clinical+laboratory+image (ABC-GOALSclx) models area under the curve were 0.79 (95%CI=0.74-0.83) and 0.77 (95%CI=0.71-0.83), 0.86 (95%CI=0.82-0.90) and 0.87 (95%CI=0.83-0.92), 0.88 (95%CI=0.84-0.92) and 0.86 (95%CI=0.81-0.90), in the development and validation cohorts, respectively. The ABC-GOALScl and ABC-GOALSclx outperformed other COVID-19 and pneumonia predictive scores. CONCLUSION: ABC-GOALS is a tool to timely predict the need for admission to ICU in COVID-19.

DERIVATION OF A SCORE TO PREDICT ADMISSION TO INTENSIVE CARE UNIT IN PATIENTS WITH COVID-19: THE ABC-GOALS SCORE (preprint)

Background. COVID-19 pandemic poses a burden on hospital resources and intensive care unit (ICU) occupation. This study aimed to provide a scoring system that, assessed upon first-contact evaluation at the emergency department, predicts the need for ICU admission. Methods. We prospectively assessed patients admitted to a COVID-19 reference center in Mexico City between March 16th and May 21st, and split them into development and validation cohorts. Patients were segregated into a group that required admission to ICU, and a group that never required ICU admission and was discharged from hospitalization. By logistic regression, we constructed predictive models for ICU admission, including clinical, laboratory, and imaging findings from the emergency department evaluation. The ABC-GOALS score was created by assigning values to the weighted odd ratios. The score was compared to other COVID-19 and pneumonia scores through the area under the curve (AUC). Results. We included 569 patients divided into development (n=329) and validation (n=240) cohorts. One-hundred-fifteen patients from each cohort required admission to ICU. The clinical model (ABC-GOALSc) included sex, obesity, the Charlson comorbidity index, dyspnea, arterial pressure, and respiratory rate at triage evaluation. The clinical plus laboratory model (ABC-GOALScl) added serum albumin, glucose, lactate dehydrogenase, and S/F ratio to the clinical model. The model that included imaging (ABC-GOALSclx) added the CT scan finding of >50% lung involvement. The model AUC were 0.79 (95%CI 0.74-0.83) and 0.77 (95%CI 0.71-0.83), 0.86 (95%CI 0.82-0.90) and 0.87 (95%CI 0.83-0.92), 0.88 (95%CI 0.84-0.92) and 0.86 (95%CI 0.81-0.90) for the clinical, laboratory and imaging models in the development and validation cohorts, respectively. The ABC-GOALScl and ABC-GOALSclx scores outperformed other COVID-19 and pneumonia-specific scores. Conclusion. The ABC-GOALS score is a tool to evaluate patients with COVID-19 at admission to the emergency department, which allows to timely predict their risk of admission to an ICU.