ABSTRACT
Background The Coronavirus 2019 (COVID-19) pandemic has posed significant challenges in the management of liver disease. Missed or delayed diagnosis of hepatocellular carcinoma (HCC) is anticipated due to discontinuity in standard surveillance protocols during the pandemic, though no large studies have documented the same. We attempted to study the baseline characteristics and outcomes in patients hospitalized with alcohol related hepatitis (AH), before and after the COVID-19 outbreak, and analyze the impact of COVID-19 on outcomes including diagnosis of HCC and inpatient mortality. Methods A federated cloud-based network (TriNetX) data from fifty health care organizations across the globe was analyzed retrospectively. Patients admitted with AH between January 2019 and December 2020 were studied. They were categorized into two groups including post-COVID outbreak (group 1, January 1st, 2020 to December 1st, 2020) and pre-COVID outbreak (group 2, January 1st, 2019 to December 1st, 2019). Patient characteristics and outcomes related to hospitalization were compared between these groups. Results Of 23,201 patients studied, 4,383 patients were included in group 1, and 18,818 in group 2. The two groups had comparable demographic features and occurrence of other comorbid diseases (table 1), none of them had a COVID-19 diagnosis. After propensity matched analysis, we found that group 1 (post-COVID group) had a tendency to have higher total bilirubin levels (p=0.05) during hospitalization. Similarly, the post-COVID group had a higher proportion of patients with underlying cirrhosis (p=0.02). Patients had a similar course during hospitalization among most of the variables compared among the two groups except the occurrence of hepato-renal syndrome (higher in the post-COVID group, p<0.001). Among the outcome variables studied, post-COVID group had an increased occurrence of HCC (Odds Ratio [OR]=1.19, CI=1.08-1.32, p<0.001), however occurrence of ascites (OR= 0.72, CI=0.45-1.17, p=0.18), hepatic encephalopathy (OR=0.74, CI=0.49-1.11, p=0.15), need for steroid use (OR=1.13, CI=0.91-1.41, p=0.24) and inpatient death (OR=0.93, CI= 0.72-1.20, p=0.59) were comparable among both groups. Conclusion Patients hospitalized with AH after the COVID-19 outbreak appear to have a higher occurrence of HCC and hepato-renal syndrome, though the occurrence of ascites, hepatic encephalopathy, need for steroid therapy and overall mortality did not change. This may indicate decreased outpatient diagnosis of HCC, likely from delay or discontinuity in standard HCC surveillance as a result of the COVID-19 outbreak. (Table presented.)