ABSTRACT
BACKGROUND Alcohol misuse is a major public health concern in the United States. Centers for Disease Control reported 261 deaths per day due to excess alcohol consumption. National Institute of Alcohol Abuse and Alcoholism reports a significant increase in alcohol sale during the current Covid-19 pandemic. We aim to study the impact of alcohol misuse during the current pandemic in inpatient admissions. METHODS We retrospectively reviewed all the hospitalizations at BronxCare Health System, a safety-net community hospital in New York City, between March and September during the years of 2017 to 2020. All adult inpatient encounters with an admitting diagnosis of decompensated alcoholic liver cirrhosis (DALC) and alcoholic hepatitis (AH) were included in our study. RESULTS We compared two groups based on time periods: pre-pandemic and pandemic. There was a significant increase in admissions in the pandemic group. We ed a total of 64 admissions for DALC and 51 for AH in the pre-pandemic group and 90 hospitalizations for DALC and 69 hospitalizations for AH in the pandemic group. The mean age of patients admitted for DALC 57 years (SD ±11) and 54 years (SD ±9) respectively, p=0.036. We observed a decrease in the number of female hospitalizations (26.3% vs 18.8%, p=0.1829) and an increase in-hospital mortality (8.7% vs 12.0%, p=0.394) related to DALC. However, these findings did not reach statistical significance. The mean age of patients admitted for AH was 48 years (SD ±10) in both the groups, p=0.34. There were no statistically significant differences in gender (24.8% vs 23.2%, p=0.8666) or in-hospital mortality (1.9% vs 4.3%, p= 0.3779). Figures 1 and 2 illustrate an increase in the number of hospitalizations related to DALC and AH during the COVID-19 pandemic. CONCLUSION There was a significant increase in admissions for DALC and AH during the Covid 19 pandemic at our safety net hospital serving a community where alcohol misuses was high. There has been disproportionate impact of Covid 19 in terms of higher mortality in safety net populations. Our study highlights the broader impact of Covid 19 on other major public health concerns including stress, anxiety further exacerbating alcoholism and alcohol abuse which may explain some of the disparities in Covid 19 related mortalities. (Figure Presented)
ABSTRACT
Introduction: Hyperlipasemia and its clinical significance in patients with COVID-19 (CoronavirusDisease 2019) has not been widely reported. Angiotensin-converting enzyme 2(ACE-2) receptors are expressed in the pancreas and a direct viral cytopathic effect resultingin pancreatic injury with SARS CoV-2 (Severe Acute Respiratory Syndrome Corona Virus-2) infection has been hypothesized. In this study, we present the largest retrospective cohortstudy to date, evaluating the significance of hyperlipasemia in patients with COVID-19.Methods: All hospitalized adults with a positive SARS CoV-2 PCR (Polymerase ChainReaction) test from March 09 to June 30, 2020, and a serum lipase level drawn on admissionwere included in our study. Hyperlipasemia is defined as a lipase level above the upperlimit of normal. Data was extracted from our electronic medical records. Statistical analysiswas performed using the SAS statistical software v. 9.4 (SAS Institute, Cary, NC, USA).Mean and standard deviations were generated for continuous variables. Frequencies andproportions were reported for categorical variables. The Student t test and the Chi-squaretest were performed for the analysis of continuous or categorical variables respectively. Alltests were 2-sided, with a statistical significance set at p < 0.05. The logistic regressionmodel was used to quantify the association between lipase levels and clinical outcomes suchas the need for mechanical ventilation and deathResults: There were a total of 900 COVID-19 positive patients, of which 282 (31.3%) hadhyperlipasemia on admission (Table 1). We compared patients with normal lipase withthose with hyperlipasemia. There were no significant differences observed between the twogroups in terms of demographic, comorbidities, presenting symptoms and widely reportedserological markers known to indicate disease severity in COVID-19. In our multivariableadjustedmodel (table 2), elevated lipase was not significantly associated with the need formechanical ventilation or in-hospital mortality. A majority of our patients had mild elevationin lipase levels. Additionally, individuals who had hyperlipasemia (49 patients 5.4%) exceeding3 times the upper limit of normal (>183 U/L), did not meet the diagnostic criteria foracute pancreatitis.Conclusion: Hyperlipasemia in COVID-19 patients was not associated with poor clinicaloutcomes such as prolonged hospital course, or need for mechanical ventilation, or death.Patients with significantly elevated lipase levels did not meet diagnostic criteria for acutepancreatitis. Our study raises a broad range of possibilities for elevated lipase in patientswith COVID-19, ranging from global hypoxemia, hypoperfusion of pancreas and bowel, inaddition to renal failure. However, hyperlipasemia was not a predictor of disease severityor clinical outcomes in COVID-19 patients.(Table Presented)(Table Presented)