ABSTRACT
Coronavirus Disease 2019 (Covid-19) Has Been Diagnosed In Over 50 Million Individuals And Resulted In Greater Than 1 Million Deaths Since Its Discovery In December 2019. Currently, It Is Understood That Cardiovascular Disease, Diabetes, Hypertension, Chronic Lung Disease, Malignancy, Chronic Renal Disease, Obesity, And Smoking Confer Worse Outcomes In Those Afflicted With Covid-19. The Role Of Underlying Gastrointestinal Comorbidities On Covid-19 Prognosis Has Not Been Well Studied. Patients With Inflammatory Bowel Disease (Ibd) Have A Slightly Higher Overall Mortality Than The General Population. While The Pathogenesis Of Ibd Is Not Completely Understood, It Is Thought To Be The Consequence Of Dysregulated Immune Response. A Pair Of Small International Studies Demonstrated That Patients With Ibd Are At Increased Risk Of Covid-19 Infection, Especially When They Have Active Disease And Are Taking Immunosuppressive Therapy. However, The Characteristics And Outcomes Of Covid-19 In Patients With Ibd Remain Unclear. We Conducted A Large-Scale, Multicenter, Retrospective Study To Examine The Outcomes In Ibd Patients Hospitalized For Covid-19. Using Hca Healthcare’S Physician Services Clinical Data Warehouse, We Reviewed 78,756 Adult Patients Across 143 Hospitals Between January Through August 2020 With Covid-19, Yielding 78,572 Covid-19 Patients Without Ibd And 184 With Ibd. Unpaired T-Tests Of Covid-19 Patients With Ibd Compared To Those Without Ibd Showed That Patients With Both Covid-19 And Ibd Experienced Significantly Higher Mortality (8.15% Vs 6.10%, P=0.004), Significantly Higher Rates Of Icu Admission (25.54% Vs 16.49%, P=0.001), Significantly Higher Rates Of Ventilation (13.04% Vs 7%, P=0.002), And Significantly Longer Lengths Of Stay (Los) (7.92 ± 9.84 Vs 4.57 ± 7.87 Days, P<0.001). The Outcomes Of Length Of Stay Remained Significant On Paired T-Test When The 184 Patients With Covid-19 And Ibd Were Age-Matched To Covid-19 Patients Without Ibd. However, There Was No Statistical Significance In Mortality, Icu Admission, And Need For Ventilation When Age-Matched. Ibd Was Independently Associated With Increased Icu Admission (Or 1.5, Ci 1.04 – 2.117, P=0.026) And Need For Ventilation (Or 1.8, Ci 1.124 – 2.775, P=0.010) On Multivariable Regression Analysis, And Los (Or 2.337, Se 0.531, P<0.001) In Linear Regression Analysis. Our Data Corroborates Previous Studies Suggesting Protective Effects Of Female Sex, And Deleterious Effects Of Increasing Age, Myocardial Infarction, Congestive Heart Failure, Cerebrovascular Disease, Chronic Pulmonary Disease, Diabetes, And Cancer. In Summary, Based On Our Study, Patients With Both Ibd And Covid-19 Experienced Significantly Increased Rates Icu Admission, Ventilation, And Lengths Of Stay Compared To Patients With Covid-19 Alone (Table Presented) (Table Presented) (Table Presented) (Table Presented)
ABSTRACT
Background: The COVID-19 pandemic changed the way Americans live and behave. Social isolation, financial crisis, and loss of loved ones add to the stressors. Research has shown increased alcohol consumption as a coping mechanism. Several reports indicate an increase in alcohol sales during the pandemic. Short term and long-term complications of this are unknown currently. We sought to determine the number of hospitalizations for alcoholic hepatitis during the COVID-19 pandemic in the United States. Method: This is a retrospective cohort study comparing hospitalizations for alcoholic hepatitis/ alcoholic hepatic failure during February 2019 to September 2019 and from February 2020 to September 2020. We analyzed HCA Healthcare’s Physician Services clinical data warehouse which aggregates data from 185 hospitals in the US. Patients were identified retrospectively using ICD-10 codes. Patient characteristics, labs, and discharge information were also collected. Categorical variables were compared using the Chi-square test and continuous variables were compared using the t-test. Results: The total number of hospitalizations for alcoholic hepatitis and alcoholic liver failure in February through September was 57,171 in 2020 vs 61,356 in 2019. This represented 7.4 % of all admissions in 2020 vs 6.5% in 2019. Admissions in Q1 (excluding January), Q2, and Q3 were 6.02%, 8.55%, and 7.74% respectively in 2020, and 6.63%, 7.05%, and 6.08% respectively in 2019. The mortality rate in 2019 was 1.35%, it increased to 2.04% in 2020 (p=0.01). There is also a 7% increase in cases among women in 2020. Conclusions: This study shows that there is a relative increase in hospitalizations for alcoholic hepatitis and alcoholic hepatic failure during the COVID-19 pandemic compared to the year before, especially in the second and third quarters of the year. Interestingly at the beginning of the pandemic when many states issued stay-at-home orders there was a 10% decrease in alcoholic hepatitis hospitalizations versus the previous year. As the prolonged uncertainty and chaos continued the hospitalizations increased by 21% in the second quarter and by 27% in the third quarter versus the prior year. We assume that as uncertainties prevailed, alcohol use increased, resulting in alcohol-related liver injuries. Additionally, the COVID-19 pandemic has seen increased alcoholic hepatitis mortality and an increase in female patients. The results shed light on a different public health aspect of the pandemic which has gone unnoticed and needs to be addressed.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has been diagnosed in at least 63.5 million individuals and resulted in 1.4 million deaths as of December 2020 since its discovery. Various risk factors for severe illness have been investigated;currently it is understood that cardiovascular disease, diabetes mellitus, hypertension, chronic lung disease, malignancy, chronic renal disease, obesity, and smoking confer worse outcomes. Liver cirrhosis is understood to be a significant source of general morbidity and mortality due, in part, to compromise of the immune system. A multicenter, retrospective examination of 50 patients with both COVID-19 and cirrhosis showed that patients with cirrhosis were at increased risk for mortality from COVID-19 than those without cirrhosis. To our knowledge, there exists no large study to examine the effect of cirrhosis on COVID-19 outcomes. We performed a multicenter, retrospective study to further examine outcomes in cirrhotic patients hospitalized for COVID-19 infection. Using the HCA Healthcare Physician Services clinical data warehouse, we reviewed 23,474 adult patients across 143 hospitals admitted from January through August 2020 with COVID-19, yielding 22,467 COVID-19 patients without cirrhosis and 1,007 with cirrhosis. Unpaired T-tests of COVID-19 patients with cirrhosis compared to those without cirrhosis showed that patients with both COVID-19 and cirrhosis experienced significantly higher mortality (17.97% vs 12.96%, p<0.001), significantly higher rates of ICU admission (45.58% vs 33.90%, p<0.001), significantly higher rates of ventilation (24.43% vs 16.07%, p<0.001), and significantly longer lengths of stay (LOS) (11.05 ± 10.86 vs 8.46 ± 10.05 days, p<0.001). The outcomes of ICU admission and length of stay remained significant on paired T-test when the 1,007 patients with COVID-19 and cirrhosis were age-matched to COVID-19 patients without cirrhosis. Cirrhosis was independently associated with increased mortality (OR 1.33, CI 1.11-1.58, p=0.002), ICU admission (OR 2.08, CI 1.16-1.52, p<0.001), and ventilation (OR 1.32, CI 1.13-1.54, p<0.001) on multivariable regression analysis. Our dataset corroborates previous studies suggesting protective effects of female sex;and deleterious effects of increasing age, myocardial infarction, cerebrovascular disease, diabetes, cancer, and obesity. Chronic pulmonary disease was significantly associated with poor outcomes of all measures except mortality. Additionally, length of stay among patients with both COVID and cirrhosis is estimated to increase by 1.65 (SE 0.31, p<0.001) on linear regression analysis. In summary, patients with both cirrhosis and COVID-19 experienced significantly increased rates of mortality, ICU admission, ventilation, and lengths of stay compared to patients with COVID-19 alone. (Table presented.)