Impact of covid-19 pandemic on non-covid-19 patients with decompensated liver cirrhosis

ABSTRACT

Introduction: The COVID-19 pandemic may have an important effect on non-COVID-19 patients, namely due to allocation of healthcare resources to COVID-19 patients. Outpatients with chronic conditions requiring frequent medical attention, like liver cirrhosis, may suffer a greater impact due to lack of access to consultations and a possible delay in emergency room admissions. Aims & Methods: Our aim is to evaluate the impact of the COVID-19 pandemic on non-COVID-19 patients with decompensated liver cirrhosis (DLC). A retrospective single center study was conducted, including patients admitted due to DLC from 15/03/2019 to 15/03/2021. DLC was defined, in cirrhotic patients, as admission due to ascites, spontaneous bacterial peritonitis (SBP), acute kidney injury (AKI), hepatic encephalopathy (EH), rupture of gastroesophageal varices (RGEV) and/or alcoholic hepatitis (AH). Hepatocellular carcinoma patients were excluded. Patients were allocated in two groups according to date of admission COVID- 19 group (C group) if admitted between 15/03/2020 and 15/03/2021 and pre-COVID-19 group (pC group) if admitted in the previous year. Demographic, clinical and laboratory variables were compared between groups. Child-Pugh and Model for End-stage Liver Disease Sodium (MELDNa) were assessed at admission. Results: One-hundred-and-forty patients were included, 74 (53%) during COVID-19 pandemic (mean age 63±12 years, with 51 males), and 66 (47%) pre-COVID-19 (mean age 63±11 years, with 46 males). Alcohol consumption was the most frequent cause of cirrhosis in both groups. The majority of patients presented with Child-Pugh C in both groups and the mean MELDNa score at admission was 22±7 points in C group and 22±8 in pC group. The most common comorbid condition was diabetes (C group n=15;20%;pC group n=25;38%) and the mean Charlson Comorbidity Index was 5±2 points in both groups (p>0.05). The presentations of DLC, in C group and pC group, were respectively ascites 77% versus (vs) 73%;AKI 39% vs 55%;HE 50% vs 46%;RGEV 14% vs 15%;AH 14% vs 6%;SBP 4% vs 14%. The median length of hospital stay was 8 days (IQR 10) in C group and 11 days (IQR 16) in pC group. Twelve patients died during hospital stay in C group (16%) and 12 in pC group (18%). The average time of follow-up was 156±119 days in C group and 112±100 days in pC group. Twenty-two deaths (30%) occurred during follow-up in C group and 15 (23%) in pC group;28 patients were readmitted during follow-up in C group (45%) and 26 (48%) in pC group. The absolute number of deaths was higher during COVID-19 (n=34 vs n=27), as well as the total number of admitted patients (n=74 vs n=66). However, mortality rates did not significantly differ in the two groups (46% vs 41%;p>0.05). SBP was more frequent in pC group (p=0.045). There was a tendency towards a higher number of first time DLC with AH during COVID- 19 (n=7 vs n=1, p=0.053). None of the other above-mentioned variables were significantly different between groups (p>0.05). Conclusion: During COVID-19 pandemic, we observed a higher absolute number of hospitalizations due to DLC and a proportional larger number of deaths. Nevertheless, severity at admission and mortality rates during and after hospitalization did not increase significantly during the pandemic period. There was a higher number of first time DLC with AH during COVID-19, which may reflect greater alcohol consumption during lockdown.