INCREASE IN ALCOHOLIC HEPATITIS CASES DURING COVID PANDEMIC IN THE US

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.