ABSTRACT
Background and Aims: Alcoholic hepatitis (AH) is associated with significant morbidity, mortality and healthcare expenditure. The global SARS-CoV-2 (COVID-19) pandemic and related lockdown measures have potentially contributed to an increase in alcohol misuse. This study examines frequency and patient outcomes of AH admissions to an Australian quaternary liver transplant referral centre. We aimed to ascertain the change in AH severity, ICU admission rates and healthcare utilisation costs over the last 5 years to identify temporal associations with the COVID-19 pandemic. Methods: A retrospective analysis of patients aged 18 years and older fulfilling National Institute on Alcohol Abuse and Alcoholism diagnostic criteria for AH between January 2016 and March 2021 was conducted. Data were collected from electronic medical records and analysed. Primary endpoints were the frequency of AH admissions, ICU admission rates and healthcare costs, which were evaluated with a divergence at the beginning of lockdown restrictions (March 2020 – March 2021 “COVID cohort”) versus the “historical cohort” (January 2016 - February 2020). Results: In total, 105 eligible AH admissions were identified. Overall, 90 day mortality was 18% (19/105). AH admission rate for the COVID cohort was significantly higher at 3.38 cases/month (n = 44) compared to the historical cohort at 1.22 cases/month (n = 61), p < 0.001. The COVID cohort had greater disease severity with a higher Glasgow Alcoholic Hepatitis Score during admission [8.5 (IQR 7-10) vs 7 (IQR 6-9), p = 0.04]. The AH COVID cohort trended towards a greater proportion requiring ICU admission, inotropic support and longer ICU length of stay. Whilst per-episode adjusted healthcare costs were similar across the study, monthly costs of the COVID cohort were higher compared to the historical cohort due to increased admission frequencies [mean (SD) ≥137,549 (54,058) vs ≥38,000 (27,448), p = 0.02 (Figure 1)]. No patients in this study were diagnosed with COVID-19. Conclusion: In this study, alcoholic hepatitis admission frequency and healthcare costs were found to have increased since the COVID-19 pandemic. These observations provide the impetus for future studies to understand how the COVID-19 pandemic has led to increased AH presentations and develop preventative strategies that reduce alcohol related admissions and associated costs (Figure Presented)
ABSTRACT
Background and Aim: Coronavirus disease 2019 (COVID-19) is now a worldwide pandemic. Gastrointestinal endoscopy is considered an aerosol-generating procedure (AGP) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. On 25 March 2020, the Prime Minister of Australia announced a nationwide suspension of all non-urgent endoscopy. There are limited data to provide insight into creating a safe model for rationing gastrointestinal endoscopy that does not compromise patient care. Our hospital mobilized a model of care, deferring all non-urgent category 2 and all category 3 cases, and created specific clinics with experienced endoscopists to re-triage outstanding cases. We aimed to conduct a retrospective study to evaluate this single-center experience. Methods: We collected data on patients who had an emergency (performed within 48 h of emergency admission) or elective gastroscopy or colonoscopy during the 5-week lockdown period (26 March to 1 May 2020). For comparison, the same analysis was performed on all those who underwent an endoscopic procedure during the same period 12 months earlier. Our primary objective was to compare the rate of highly significant abnormalities detected during these two periods. Highly significant abnormalities were defined as upper or lower gastrointestinal malignancy, adenomatous polyps larger than 2 cm, or a new diagnosis of inflammatory bowel disease. Furthermore, we evaluated all gastrointestinal malignancy diagnoses over the past 2 years, identifying the triage category, indication, endoscopic and histological findings, and the rate of malignancy diagnosis. Results: During the COVID-19 era, 66% fewer procedures were performed than in the previous year's corresponding period (141 procedures [79% category 1, 21% category 2] vs 410 procedures [45% category 1, 45% category 2, 10% category 3];P < 0.001). The numbers of emergency endoscopies were similar (16 in COVID-19 era vs 18 pre-COVID-19). A comparable number of highly significant abnormalities were found (Table 1). The six new malignancy diagnoses in the COVID-19 era were in keeping with our median monthly cancer rate of 5.5 (IQR, 3-6.3) over the past 2 years. Of the 4621 gastroscopies and 4573 colonoscopies performed in the past 2 years, 94% of the newly diagnosed upper and lower gastrointestinal cancers were triaged as category 1, 6% as category 2, and none as category 3. Conclusion: Our findings suggest that significant and time-critical abnormalities are unlikely to be missed by a model of care prioritizing category 1 and urgent category 2 upper and lower endoscopies, as we did during the COVID-19 shutdown. These reassuring findings may help guide the approach to endoscopy management if another shutdown occurs here or overseas, especially given the recent spike in COVID-19 cases in Victoria.