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1.
Alcohol Clin Exp Res ; 46(7): 1248-1257, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1973530

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in disruptions across many life domains. The distress associated with the pandemic itself, and with public health efforts to manage the outbreak, could result in increased alcohol use. This study aimed to quantify changes in alcohol use during the early stages of the pandemic and factors associated with different patterns of use. METHODS: Data were obtained from a longitudinal survey of a representative Australian adult sample (N = 1296, 50% female, Mage  = 46.0) conducted from March to June 2020, during the first wave of the COVID-19 outbreak in Australia. Change in alcohol consumption was examined using Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores from waves one, three, five, and seven of the study, each 4 weeks apart. Factors associated with alcohol consumption were examined, including depression (PHQ-9) and anxiety (GAD-7) symptoms, health risk tolerance, stress and coping, work and social impairment (WSAS), COVID impacts, and sociodemographic variables. We tested changes in alcohol use across the full sample using a mixed effects repeated measure ANOVA model and a multinomial logistic regression to identify factors assessed at wave 1 that were independently associated with alcohol use. RESULTS: There was no significant change in AUDIT-C scores across the study. For most participants, alcohol use did not increase during the early phase of the COVID-19 pandemic in Australia. COVID-19 exposure, higher perceived coping, depression symptoms, and male gender were associated with greater odds of increasing or elevated levels of alcohol use. Social changes, which included working from home, had mixed effects on alcohol consumption. CONCLUSIONS: Although no evidence was found for increased alcohol use overall during the early months of the pandemic, several factors were associated with alcohol consumption at risky levels. Greater understanding of motivations for drinking across public and private contexts, along with targeted support for high-risk groups, could assist in reducing harm associated with alcohol consumption.


Subject(s)
Alcoholism , COVID-19 , Adult , Alcohol Drinking/epidemiology , Alcoholism/epidemiology , Australia/epidemiology , COVID-19/epidemiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics
2.
Aust N Z J Public Health ; 46(4): 429-437, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1973516

ABSTRACT

OBJECTIVE: To determine the geographical location and characteristics of on-demand delivery services operating in New Zealand. METHODS: We systematically searched the web and application (app) stores for on-demand services offering rapid delivery of food, alcohol, cigarettes or vaping products in New Zealand and mapped their geographic location as of May 2021. Using desktop review, data on service characteristics were collected and stratified including: types of commodities available, promotion strategies, and the legal aspects of access to age-restricted items. RESULTS: On-demand services for food, alcohol and nicotine products operate across urban and rural New Zealand. All services offered personal memberships and 97% used promotions. All services offering restricted items had an age verification process, however, only 87% had birth date entry and 73% had an 18+ message pop-up on website entry. Only 60% of services appeared to have number limits on restricted items. CONCLUSIONS: Much of New Zealand is serviced by on-demand delivery services. IMPLICATIONS FOR PUBLIC HEALTH: The trend towards on-demand delivery services may increase unhealthy food, alcohol and nicotine-related harms and it undermines current government actions, e.g. the Smokefree 2025 goal. This research informs policy to reduce the future health burden.


Subject(s)
Electronic Nicotine Delivery Systems , Tobacco Products , Vaping , Humans , New Zealand , Nicotine
3.
J Psychoactive Drugs ; : 1-8, 2022 Jul 31.
Article in English | MEDLINE | ID: covidwho-1972820

ABSTRACT

Suicide is a leading cause of morbidity worldwide. Among the known risk factors, alcohol use disorders (AUDs) are particularly relevant, but data on the epidemiology and characteristics of suicide attempts (SA) in this group are lacking. We used electronic health records of national health services to identify individuals who received a diagnosis of AUD in the Metropolitan area of Bologna from 2009 to 2019. In this cohort we identified accesses to Emergency Departments for SA from 2009 to 2020. The Crude Suicide Rate (CSR) for 1,000 Person Years was 2.93, higher than the general population. The CSR was higher in females, within one year from receiving the diagnosis of AUD, in patients with psychiatric comorbidities, concomitant abuse of cannabis or benzodiazepines. As for Covid-19 pandemic, the risk ratio of SA was significantly higher in 2020 compared to 2019 in females. Our results are relevant to identify clinical risk factors for SA in patients with AUDs, which are strongly associated with suicide risk but with scarce data in the previous literature and paucity of evidence-based therapeutic interventions.

4.
Ir J Psychol Med ; : 1-6, 2022 Aug 02.
Article in English | MEDLINE | ID: covidwho-1972472

ABSTRACT

INTRODUCTION: Given the evidence that drinking patterns and self-harm hospital presentations have changed during COVID-19, this study aimed to examine any change in self-harm and suicide-related ideation presentations, together with any possible contribution made by alcohol or substance misuse, to Irish Emergency Departments in 2020, compared with 2018 and 2019. METHODS: A population-based cohort with self-harm and suicide-related ideation presenting to Irish hospitals derived from the National Clinical Programme for Self-Harm was analysed. Descriptive analyses were conducted based on sociodemographic variables and types of presentation for the period January to August 2020 and compared with the same period in 2018 and 2019. Binomial regression analyses were performed to investigate the independent effect of demographic characteristics and pre/during COVID-19 periods on the use of substances as contributory factors in the self-harm and suicide-related ideation presentations. RESULTS: 12,075 presentations due to self-harm and suicide-related ideation were recorded for the periods January-August 2018-2020 across nine emergency departments. The COVID-19 year was significantly associated with substances contributing to self-harm and suicide-related ideation ED presentations (OR = 1.183; 95% CI, 1.075-1.301, p < 0.001). No changes in the demographic characteristics were found for those with self-harm or suicide-related ideation across the years. Suicide-related ideation seemed to be increased after May 2020 compared with previous years. In terms of self-harm episodes with comorbid drug and alcohol overdose and poisoning, these were significantly increased in January-August 2020, compared with previous timepoints (χ2 = 42.424, df = 6, p < 0.001). CONCLUSION: An increase in suicide-related ideation and substance-related self-harm presentations may indicate longer term effects of the pandemic and its relevant restrictions. Future studies might explore whether those presenting with ideation will develop a risk of suicide in post-pandemic periods.

5.
Farmers Weekly ; 2022(Mar 4):38-40, 2022.
Article in English | Africa Wide Information | ID: covidwho-1970606
6.
BMJ Nutrition, Prevention and Health ; 2022.
Article in English | EMBASE | ID: covidwho-1968290

ABSTRACT

Objectives: Intermittent fasting boosts some host defence mechanisms while modulating the inflammatory response. Lower-frequency fasting is associated with greater survival and lower risk from COVID-19-related comorbidities. This study evaluated associations of periodic fasting with COVID-19 severity and, secondarily, initial infection by SARS-CoV-2. Design: Prospective longitudinal observational cohort study. Setting: Single-centre secondary care facility in Salt Lake City, Utah, USA with follow-up across a 24-hospital integrated healthcare system. Participants: Patients enrolled in the INSPIRE registry in 2013-2020 were studied for the primary outcome if they tested positive for SARS-CoV-2 during March 2020 to February 2021 (n=205) or, for the secondary outcome, if they had any SARS-CoV-2 test result (n=1524). Interventions: No treatment assignments were made;individuals reported their personal history of routine periodic fasting across their life span. Main outcome measures: A composite of mortality or hospitalisation was the primary outcome and evaluated by Cox regression through February 2021 with multivariable analyses considering 36 covariables. The secondary outcome was whether a patient tested positive for SARS-CoV-2. Results: Subjects engaging in periodic fasting (n=73, 35.6%) did so for 40.4±20.6 years (max: 81.9 years) prior to COVID-19 diagnosis. The composite outcome occurred in 11.0% of periodic fasters and 28.8% of non-fasters (p=0.013), with HR=0.61 (95% CI 0.42 to 0.90) favouring fasting. Multivariable analyses confirmed this association. Other predictors of hospitalisation/mortality were age, Hispanic ethnicity, prior MI, prior TIA and renal failure, with trends for race, smoking, hyperlipidaemia, coronary disease, diabetes, heart failure and anxiety, but not alcohol use. In secondary analysis, COVID-19 was diagnosed in 14.3% of fasters and 13.0% of non-fasters (p=0.51). Conclusions: Routine periodic fasting was associated with a lower risk of hospitalisation or mortality in patients with COVID-19. Fasting may be a complementary therapy to vaccination that could provide immune support and hyperinflammation control during and beyond the pandemic. Trial registration: Clinicaltrials.gov, NCT02450006 (the INSPIRE registry).

7.
Fundamental and Clinical Pharmacology ; 36:65-66, 2022.
Article in English | EMBASE | ID: covidwho-1968108

ABSTRACT

Introduction: Incidence of hospitalisations related to psychoactive substance intoxication (H-SPA) might have been differently impacted by the Covid-19 pandemic according to age-groups. This study aimed to describe (i) the incidence of H-SPA during and after the first 2020 lockdown in adults aged 18-29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017-2019 baseline period. Material and methods: This historical cohort study was conducted in adults admitted to the University Hospital of Bordeaux with main or secondary diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-SPA were described according to patients age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). Results: Among the 5824 stays included over the study period, SPA most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-SPA's incidence was more important in young adults (-40%;nbaseline = 450) in comparison to those aged 30+ (-18%;nbaseline = 1,101) during the pandemic period, especially during the lockdown compared to 2017 (-59%;n2017 = 145 vs-35%;n2017 = 166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalization indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides increased during lockdown compared to the baseline period (almost 50% vs 29%) and the proportion of accidents in context of intoxication (3.5 vs 0.7%) after lockdown. Discussion/Conclusion: The period following lockdown should be considered at risk for hospitalizations due to accident in context of SPA use. Strong decrease in the incidence of H-SPA in young adult during the lockdown highlights the health burden of recreational use of alcohol and ecstasy in this population and the need for prevention.

8.
Fundamental and Clinical Pharmacology ; 36:37-38, 2022.
Article in English | EMBASE | ID: covidwho-1968100

ABSTRACT

Introduction: At the beginning of the COVID-19 epidemic, the French Addictovigilance Network alerted on the need to facilitate access to methadone, while maintaining the safety of its use, to avoid the occurrence of overdoses and deaths. The impact of the lockdown on methadone-use related hospitalizations (MUH) has not been analyzed at the national level. The objectives of the study were to assess the impact of the lockdowns on the incidence of the MUHs and describe the characteristics of patients and hospitalizations. Material and methods: This retrospective study was conducted on patients hospitalized in France for methadone poisoning (ICD-10: T40.3) between January 2014 and December 2020, using the database of the Programme de Médicalisation des Systèmes d'Information. An interrupted time series using the Unobserved Components Model was performed to predict the monthly incidence of MUHs in 2020 on the basis of previous years data and confronted to MUHs really observed. The characteristics of the patients (age, sex, comorbidities) and hospitalizations (regions, duration of hospitalization, co-consumptions) were described over four time-periods: before lockdown, first lockdown, after-first lockdown, second lockdown. Results: Compared to the predictions, higher incidence of MUHs was found during the first month of lockdown (March) (66 cases vs. 51.3;IC95%: 34-65) and a large increase during the month following the end of the first lockdown (June) (79 cases vs. 61;IC95%: 46-75). Psychiatric comorbidities, psycho-social difficulties and co-consumptions (alcohol, cannabis, cocaine) were more observed during first lockdown, whereas patients aged over 30 years old and from Nouvelle-Aquitaine, Occitanie and Bretagne were more concerned after. The second lockdown did not present any particularity. Discussion/Conclusion: First lockdown had a significant impact on the incidence of MUHs. These results converge with the data from the reinforced national monitoring showing that methadone was the first substance involved in overdoses and deaths during and after the first lockdown [1].

9.
Alcoholism: Clinical and Experimental Research ; 46:310A, 2022.
Article in English | EMBASE | ID: covidwho-1968052

ABSTRACT

Purpose: Risky overdose behaviors, such as using drugs by oneself, and risky sexual behaviors, such as engaging in unprotected sex, can lead to serious health outcomes, including experiencing a drug overdose and contracting HIV. During the COVID-19 pandemic, we have seen alarming increases in depression and anxiety, as well as COVID-19 fears and worries. A better understanding of how mental health symptoms and fears surrounding the COVID-19 pandemic have impacted risk behaviors is crucial to remedying the growing public health concern of increasing overdoses and HIV infections. The goal of this project is to measure the potential impact of anxiety, depression, and COVID-19 fears on overdose and sexual risk behaviors. Brief statement of methods used: Adults (n = 214) who resided in Texas and reported regular use of illicit drugs were considered eligible for a longitudinal study assessing mental health among PWUD during COVID-19. For this secondary analysis, we used measures of anxiety (GAD-7), depression (CES-D), fear of COVID-19 (FCV-19), overdose risk behavior, and HIV and sexual risk behavior. We performed Fisher's odds ratio tests to determine whether scoring above the clinical cutoffs for anxiety, depression, or fear of COVID-19 significantly affected the risk of engaging in certain overdose or HIV and sexual risk behaviors. Summary of results: In regard to overdose risk behaviors, we found that high scores of anxiety and depression significantly increased the likelihood of using opioids and alcohol at the same time. Higher levels of anxiety also significantly raised the odds of using opioids alone or witnessing an overdose. Concerning HIV risk behaviors, high scores of anxiety significantly increased the odds of injecting drugs. On the contrary, high scores of COVID-19 fear significantly decreased the odds of engaging in sexual activity with someone who did not know their HIV status. Statement about conclusion: These results showed that individuals experiencing high levels of anxiety or depression are at a greater risk of engaging in risky behaviors that may lead to experiencing an overdose, while fear of COVID-19 may act as a protective factor against sexual risk behaviors. Harm reduction resources and safer drug use education should be made available to those most vulnerable.

10.
Intern Med ; 61(15): 2333-2337, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1968927

ABSTRACT

Metformin-associated lactic acidosis (MALA) is an extremely rare but life-threatening adverse effect of metformin treatment. The lifestyle changes associated with the coronavirus disease 2019 (COVID-19) pandemic may increase the potential risk of MALA development in patients with diabetes. We herein report a 64-year-old Japanese man taking a small dose of metformin who presented with MALA accompanied by hypoglycemia secondary to increased alcohol consumption triggered by lifestyle changes during the pandemic. Physicians should prescribe metformin judiciously to prevent MALA development and pay close attention to lifestyle changes in patients at risk for MALA during the COVID-19 pandemic.


Subject(s)
Acidosis, Lactic , COVID-19 , Diabetes Mellitus, Type 2 , Hypoglycemia , Metformin , Acidosis, Lactic/chemically induced , Diabetes Mellitus, Type 2/complications , Humans , Hypoglycemia/drug therapy , Hypoglycemic Agents/adverse effects , Male , Metformin/adverse effects , Middle Aged , Pandemics
11.
BMC Public Health ; 22(1): 1446, 2022 07 29.
Article in English | MEDLINE | ID: covidwho-1968565

ABSTRACT

The COVID-19 pandemic has had a significant impact on daily life, affecting both physical and mental health. Changes arising from the pandemic may longitudinally impact health-related behaviors (HRB). As different HRBs co-occur, in this study, we explore how six HRBs - alcohol (past-week and binge-drinking), tobacco, marijuana, benzodiazepine use, and unhealthy food consumption - were grouped and changed over time during the COVID-19 pandemic. A sample of 1038 university students and staff (18 to 73 years old) of two universities completed an online psychometrically adequate survey regarding their recalled HRB (T0, pre-COVID-19 pandemic) and the impact of COVID-19 on their behaviors during July (T1) and November (T2). Latent Transition Analysis (LTA) was used to identify HRB cluster membership and how clusters changed across T0, T1, and T2. Four clusters emerged, but remained mainly stable over time: 'Lower risk' (65.2-80%), 'Smokers and drinkers' (1.5-0.01%), 'Binge-drinkers and marijuana users' (27.6-13.9%), and 'Smokers and binge-drinkers' (5.6-5.8%). Participants who moved from one cluster to another lowered their HRB across time, migrating from the 'Binge-drinkers and marijuana users' cluster to 'Lower risk'. Participants in this cluster were characterized as less affected economically by the COVID-19 pandemic, with lower reported stress levels, anxiety, depression, and loneliness than the other clusters. Our results provide evidence of how HRBs clustered together and transitioned longitudinally during the COVID-19 pandemic. HRB clustering across time offers a valuable piece of information for the tailoring of interventions to improve HRB.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , COVID-19/epidemiology , Cluster Analysis , Health Behavior , Humans , Middle Aged , Pandemics , Universities , Young Adult
12.
Addiction ; 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1968053

ABSTRACT

AIMS: Government alcohol sales data were used to examine whether age 15+ per-capita alcohol consumption (PCAC) (i) changed during COVID-19 and (ii) predicted COVID-19 infections 2-5 weeks later. DESIGN: Interrupted time-series analyses were applied to panels of data before and after COVID-19 restrictions were introduced in Canada. SETTING AND PARTICIPANTS: The populations, aged 15+, of the provinces of Ontario (ON), British Columbia (BC) and Nova Scotia (NS), Canada. INTERVENTION: Expansion of home delivery options and hours of trading for liquor stores while restrictions on travel, social and economic activities were imposed by governments during COVID-19 from 17 March 2020 until 29 March 2021. MEASUREMENTS: Weekly estimates of (i) age 15+ PCAC using sales data supplied by provincial government alcohol distributors for liquor stores, bars and restaurants, (ii) stringency of public health measures assessed by the Public Health Agency of Canada (PHAC) and (iii) new COVID-19 infections reported by PHAC. FINDINGS: PCAC increased by 7.10% (P = 0.013) during the pandemic versus previous years, with increased private liquor store sales partly offset by reduced bar/restaurant sales. Consumption was positively associated with stringency of public health measures. Weekly PCAC was positively associated with new COVID-19 infections 2 weeks later (+6.34% for a one drink/week increase, P < 0.001). Lagged associations with COVID-19 infections 2 or 3 weeks later were observed for PCAC from all sales channels, with larger effect sizes per standard drink/person/week increase for on-premise outlets (+77.27% week 2, P = 0.009) than government liquor stores (+6.49%, week 2, P < 0.001) or private liquor stores (+7.13%, week 4, P < 0.001). CONCLUSIONS: Alcohol consumption increased in three Canadian provinces during COVID-19 to degrees corresponding to the extent of the strictness of measures imposed to prevent viral spread. Increased consumption of alcohol was associated with increased COVID-19 infection rates 2 weeks later.

13.
Laryngo- Rhino- Otologie ; 101:S314, 2022.
Article in English | EMBASE | ID: covidwho-1967680

ABSTRACT

Background To date, systematic studies on the cause and prevalence of childhood hyposmia are lacking. The causes of this olfactory dysfunction can vary from simple adenoid hyperplasia or a condition following covid-19 infection to the rare Kallmann syndrome. Regardless of the entity, olfactory disorders can not only severely limit children's quality of life but also present a diagnostic challenge. Methods In the period from March to October 2021, 66 children (33 female, 33 male) between 5 and 18 years of age were examined. 41 of these children showed hyperplasia of the lymphatic tissue (adenoid vegetations and/or tonsillar hyperplasia). 25 healthy children without lymphatic hyperplasia were included in the control group. By means of the 'U-Sniff Test', an olfactory test validated for children, the preoperative olfactory ability was assessed. In addition to the known 12 olfactory sticks, we added two additional odors (chewing gum and ethanol). Results 39 % of the children with lymphoid hyperplasia showed a result below 8 points in the 'U-Sniff Test', while the controle group had regular test results. Children with lymphoid tissue hyperplasia were significantly more likely to be diagnosed with hyposmia than are children from the control group (p < 0.01). Odors unpleasant for children, such as fish or coffee, were more reliably detected than fragrant smells. The odor chewing gum was recognized by 91 % of the children in the age group under 6 years of age. The childrens origin or eating habits showed no correlation with their performance in the 'U-sniff Test'. Conclusion Children with lymphoid hyperplasia suffer significantly more often from hyposmia than children without adenoid/tonsillar hyperplasia. There is an evidence gap in the literature regarding this correlation.

14.
Journal of Hepatology ; 77:S142, 2022.
Article in English | EMBASE | ID: covidwho-1967495

ABSTRACT

Background and aims: In trials conducted in India, recombinant granulocyte colony stimulating factor (GCSF) improved survival in alcohol-associated hepatitis (AH). The aim of this trial was to determine the safety and efficacy of pegfilgrastim, a long-acting recombinant GCSF, in patients with AH in the United States. Method: This prospective, open label trial randomized patients with a clinical diagnosis of AH and a Maddrey discriminant function score ≥32 to standard of care (SOC) or SOC+pegfilgrastim (0.6 mg subcutaneously) on Day 1 and Day 8. SOC was 28 days of either pentoxifylline or prednisolone, as determined by the patient’s primary physician. The second injection of pegfilgrastim was not administered if the white blood cell count exceeded 30, 000/mm3 on Day 8. Primary outcomewas survival at Day 90. Secondary outcomes included the incidence of acute kidney injury (AKI), hepatorenal syndrome (HRS), hepatic encephalopathy, or infections. Results: The study was terminated early due to COVID19 pandemic. Eighteen patients were randomized to SOC and 16 to SOC+pegfilgrastim. All patients received prednisolone as SOC. Nine patients failed to receive a second dose of pegfilgrastin due to WBC>30, 000/ mm3 on Day 8. Survival at 90 days was similar in both groups (SOC: 0.83 [95% confidence interval {CI}: 0.57–0.94] vs. pegfilgrastim: 0.73 [95% CI: 0.44–0.89];p > 0.05). The incidences of AKI, HRS, hepatic encephalopathy, and infections were similar in both treatment arms and therewere no serious adverse events attributed to pegfilgrastim. Conclusion: This phase II trial found no survival benefit at 90 days among subjects with AH who received pegfilgrastim+prednisolone compared with subjects receiving prednisolone alone.

15.
Journal of Hepatology ; 77:S63, 2022.
Article in English | EMBASE | ID: covidwho-1967494

ABSTRACT

Background and aims: Identification and staging of fibrosis is a critical part of assessment for people with alcohol related liver disease. For those presenting acutely in hospital, staging tests are frequently deferred until out-patient review. However, engagement with elective services is often poor in those with ongoing alcohol use, leaving investigation incomplete and the need for hepatology followup uncertain. To mitigate this, we instituted an in-patient fibrosis assessment service within our Alcohol Care Team (ACT) and evaluated the results. Method: From February 2020-October 2021, we sought out acutely admitted patients who had been identified as drinking excessively (more than the United Kingdom guidance of 14 units/week) and who had previously not engaged with the ACT for staging of suspected liver disease. All patients were staged by Fibroscan (Echosens). Enhanced Liver Fibrosis (ELF) test was additionally performed when it became available at our facility. Implementation of the pilot was delayed and disrupted due to the impact of Covid-19 on service delivery, with most patients identified from March 2021 onwards. Results: 70 patients were identified-45 (64%) male, 25 (36%) female, with median age 53 years (range 25–80 yr). Fibroscan results ranged from 3.4 kPa–75 kPa. 40 (57%)were normal (<7.0 kPa),13 (19%) F1–F3 (7.1 kPa–18.5 kPa) and 17 (24%) F4 (>18.5 kPa). ELF was performed in 32 (46%) patients;19 (59%) showed severe fibrosis (score 9.8–14.3) and 13 (41%) moderate fibrosis (score 7.9–9.6). ELF and Fibroscan werewell matched for identification of cirrhosis, with cirrhotic range Fibroscan results only found in those with severe fibrosis on ELF, suggesting either test could be used to rule out cirrhosis in this group. Following Fibroscan assessment, annual ACT follow-up was arranged for all patients in F1–F3 range, and the 25 patients with a normal Fibroscan who continued to drink excessively. Patients with any results in the cirrhotic rangewere referred to hepatology for ongoing management. Conclusion: By performing fibrosis assessment during an inpatient stay, wewere able to exclude significant liver disease in many people we had previously been unable to stage, providing important information to the patient and avoiding unnecessary hepatology follow-up. Provision of in-patient non-invasive fibrosis assessment may therefore be a valuable addition to hospital ACT services for capturing patients who poorly engage.

16.
Journal of Hepatology ; 77:S49-S50, 2022.
Article in English | EMBASE | ID: covidwho-1967493

ABSTRACT

Background and aims: A global study with equitable participation for cirrhosis and chronic liver disease (CLD) outcomes is needed. We initiated the Chronic Liver disease Evolution And Registry for Events and Decompensation (CLEARED) study to provide this global perspective. Aim to evaluate determinants of inpatient mortality and organ dysfunction in a multi-center worldwide study. Method: We prospectively enrolled pts with CLD/Cirrhosis >18 years without organ transplant or COVID-19 who were admitted non-electively. To maintain equity in outcome analysis, a maximum of 50 pts/site were allowed. Data for admission variables, hospital course, and inpatient outcomes (ICU, death, organ dysfunction [ODF]) were recorded. This was analyzed for death and ODs using significant variables on admission and including World Bank classification of low/middle-income countries (LMIC). A model for in-hospital mortality for all variables during the hospital course, including ODs) was analyzed. Results: 1383 pts (55 ± 13 yrs, 64% men, 39% White, 30% Asian, 10% Hispanic, 9% Black, 12% other) were enrolled from 49 centers (Fig A). 39% were from high-income while the rest were from LMICs. Admission MELDNa 23 (6–40) with history in past 6 months of hospitalizations 51%, infections 25%, HE 32%, AKI 23%, prior LVP 15%, hydrothorax 8% and HCC 4%. Leading etiologies were Alcohol 46% then NASH 23%, HCV 11% and HBV 13%. Most were on lactulose 52%, diuretics 53%, PPI 49% and statins 11%, SBP prophylaxis 16%, beta-blockers 35% and rifaximin 31%. 90% were admitted for liver-related reasons;GI bleed 30%, HE 34%, AKI 33%, electrolyte issues 30%, anasarca 24% and 25% admission infections. In-hospital course: Median LOS was 7 (1–140) days with 25% needing ICU. 15% died in hospital, 3% were transplanted, 46% developed AKI,15% grade 3–4 HE, 14% shock, 13% nosocomial infections and 13% needed ventilation. Logistic Regression: Fig B shows that liver-related/unrelated factors on admission which predicted in-hospital mortality and development of organ dysfunction with MELDNa and Infections being common among all models. Nosocomial infections and organ dysfunctions predicted mortality when all variables were considered. High-income countries had better mortality outcomes likely due to transplant and ICU availability. AUCs were >0.75 (Figure Presented) Conclusion: In this worldwide equitable experience, admission cirrhosis severity and infections are associated with inpatient outcomes, which are greater in low-income settings. Liver-related and unrelated factors and regional variations are important in defining critical care goals and outcome models in inpatients with cirrhosis.

17.
Gastroenterology ; 162(7):S-1284, 2022.
Article in English | EMBASE | ID: covidwho-1967448

ABSTRACT

BACKGROUND: Turmeric (curcumin) is a commonly used over-the-counter herbal product whose uses include diarrhea, arthritis, cancer and even COVID-19. Recently turmeric has been implicated in cases of clinically apparent liver injury with jaundice. The aim of this case series is to describe the clinical, histologic and human leukocyte antigen (HLA) associations of turmeric-associated hepatotoxicity as seen in the U.S. Drug Induced Liver Injury Network (DILIN) Prospective Study. METHODS: All adjudicated cases enrolled in DILIN between 2003-2020 with turmeric as an implicated product were reviewed. Causality was assessed using a 5-point expert opinion score. Available products were collected and analyzed for the presence of turmeric using ultra-high-performance liquid chromatography. Genetic analyses included HLA sequencing. RESULTS: Of 1697 cases of drug-induced liver injury judged to be definite, highly likely or probable (high confidence), nine (0.5%) were attributed to turmeric, all of which were enrolled since 2012, and 6 since 2017 (Figure). The 9 cases included 7 women, 8 whites, with a mean age of 51 years (range, 35-62 years) and BMI 25 kg/m2 (range, 15-40). Seven patients used alcohol, but none to excess, and none had underlying liver disease. Turmeric was used for an average of 102 days before onset of injury (range, 30-425 days). Initial mean ALT was 1179 U/L (range, 328-2245), ALP 211 U/L (41-441), total bilirubin 5.9 mg/dL (1.2-10.8), and INR 1.0 (0.9-1.2). Six patients developed jaundice, and serum bilirubin peaked at 9.6 mg/dL (0.8-26), and INR 2.3 (1.0- 9.7). Liver injury was hepatocellular in 8 patients (mean R = 22). Five patients had elevated antinuclear antibody (ANA) titer and two anti-smooth muscle (ASM) antibody, but none were treated with corticosteroids. Liver biopsy in 5 patients showed portal and lobular mixed inflammatory infiltrates with lymphocytes and eosinophils typical of drug-induced liver injury. Five patients were hospitalized, and one patient died of acute liver failure. Chemical analysis confirmed the presence of turmeric in all 7 products analyzed;3 also contained piperine (black pepper), and none contained green tea. Of 7 patients with HLA typing available, 4 carried HLA-B*35:01, a class I HLA allele previously implicated in both green tea and Polygonum multiflorum hepatotoxicity. CONCLUSION: Liver injury due to turmeric appears to be increasing, perhaps, reflecting usage patterns or increased combination with black pepper, which increases its absorption. Turmeric liver injury, similar to that caused by other polyphenolic herbal products, is typically hepatocellular, with a latency of 1 to 6 months, and is linked to HLA-B*35:01. While most cases are self-limited, the injury can be severe and result in death or liver transplantation.

18.
Gastroenterology ; 162(7):S-1280, 2022.
Article in English | EMBASE | ID: covidwho-1967446

ABSTRACT

Background & Aims: Prior studies have indicated the presence of hepatic inflammation (as signified by elevated liver function test (LFT) values), as conferring an escalated risk toward adverse outcomes in patients admitted with COVID-19. In line with this hypothesis, we study the various thresholds of LFTs and its associated prognostic risks toward COVID- 19 related hospital deaths Method: This was a single-center retrospective study involving patients admitted with COVID-19. Univariate Cox regression analysis identified the LFT variables significantly associated with our primary endpoint, in-hospital death. Subsequently, 500 iterations of thresholds were generated for each biomarker to estimate the prognostic relationship between biomarker and endpoint. Multivariate Cox regression and event-analyses were performed for each threshold to identify the minimal cutoffs at which the prognostic relationship was significant. Event curves were drawn for each significant relationship. Results: A total of 858 patients with COVID-19 were included with a median follow-up time of 5 days from admission. From the total, 90 patients passed away during admission (10.5%). The deceased cases were more likely to be older (66.2 vs 55.3y p<0.001);however, there was no difference in gender (male: 66 vs 56.2% p=0.11). Between the cases and controls (no-death), deceased cases had higher incidence of nonalcoholic fatty liver disease (7.78 vs 2.99% p=0.042), COPD (18.9 vs 7.80% p=0.001), lung cancer (4.44 vs 0.65% p= 0.009), ICU admissions (81.1 vs 26% p<0.001), and intubation events (84.4 vs 19.5% p<0.001), however there was no difference in alcohol use (21.1 vs 30.6% p=0.083) and alcoholic liver disease (5.56 vs 2.08% p=0.097). Upon univariate Cox analysis, the following LFT parameters were associated with in-hospital death: Bilirubin (p<0.001), AST (p<0.001), ALT (p<0.001). However, alkaline phosphatase (p=0.449) was not associated with the primary endpoint. The iterations of event regression analyses using 500 sequences of LFT thresholds showed the following cutoffs to be significantly associated with in-hospital death (minimally significant values): ALT (281.71 IU/L), AST (120.94 IU/L), bilirubin (2.615 mg/ dL). On the multivariate analysis, while controlling for demographics and cardiopulmonary/ medical comorbidities, the following adjusted hazard ratios were derived for each cutoff: ALT (aHR: 6.43 95%CI 1.85-22.40), AST (aHR: 3.35 95%CI 1.84-6.11), and bilirubin (aHR: 2.77 95%CI 1.15-6.65). Conclusion: The delineated cutoffs for AST, ALT, and bilirubin levels can serve as clinical benchmarks to help determine when a COVID-19 infection poses significant risk. Given this finding, the cutoffs can be used as part of a risk assessment for patients to support early preventative therapies and medical management. (Table Presented)

19.
Gastroenterology ; 162(7):S-1278, 2022.
Article in English | EMBASE | ID: covidwho-1967444

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)

20.
Gastroenterology ; 162(7):S-1251, 2022.
Article in English | EMBASE | ID: covidwho-1967440

ABSTRACT

Background and Aim: The COVID-19 pandemic has modified liver disease-related care delivery with implementation of telemedicine, previously unavailable in safety net settings. We aimed to assess patient satisfaction with telemedicine for hepatology care (telehepatology) in vulnerable populations with fatty liver disease (FLD). Methods: From 06/01/2020-11/ 30/2021, 218 consecutive participants with non-alcoholic or alcohol-related FLD with or without advanced fibrosis/cirrhosis receiving care in hepatology clinics within the San Francisco safety net health care system were surveyed by phone or in person. Sociodemographic and clinical parameters were captured by self-report and through the electronic medical record. Satisfaction with telehepatology was measured using a Likert scale from 1-5 with 1 representing “very dissatisfied” and 5 representing “very satisfied”. Median time of survey assessment since onset of the pandemic (03/01/2020) was 60.3 (range 8.7-90.3) weeks. Alcohol use in the prior 12 months was categorized as none, moderate (#1 drink/day for women and #2 drinks/day for men), and heavy (>moderate). Severity of liver disease was assessed by liver biopsy (n=97), MR elastography (n=88), or presence of liver nodularity on abdominal imaging (n=33). Descriptive analyses were performed and multivariable models were used to assess factors associated with satisfaction with telehepatology, adjusting for age, sex, and time since pandemic onset. Results: Median participant age was 52 years, 62% were female;60% Hispanic, 20% Asian, 11% White, 3% Black, 6% other race/ethnicity;and 75% were non-English speakers. 37% used alcohol (23% had heavy alcohol use), 40% had diabetes, and 35% had advanced (stage 3-4) fibrosis/cirrhosis. 166 participants (76%) had received telemedicine care and 126 (58%) had telehepatology. Overall, 72% reported satisfaction (55% very satisfied) with telehepatology. A similar proportion of those with and without advanced fibrosis/cirrhosis were satisfied with telehepatology (70% vs 71%, p=1.0). Alcohol consumption (vs none) especially moderate use appeared to be associated with less satisfaction (Coef -1.1, p=0.004 for moderate use and Coef -0.5, p=0.2 for heavy use) but no other sociodemographic or clinical factors were associated with telehepatology satisfaction on multivariable analysis. Conclusions: In this diverse and vulnerable population, in which a significant proportion had advanced fibrosis/cirrhosis FLD, over 70% were satisfied with telehepatology. Importantly, alcohol use negatively impacted perceived satisfaction with telehepatology, suggesting that patients who use alcohol may benefit from adaptations to telemedicine care delivery. As vulnerable populations have known barriers to healthcare access, telehepatology represents an important modality for liver care, and has the potential for reducing health disparities.

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