PATIENTS WITH CIRRHOSIS EXPERIENCE HIGHER ICU MORTALITY COMPARED TO NON-CIRRHOTIC PATIENTS WHICH CONTINUED WITH OR WITHOUT COVID-19 DESPITE CONTROLLING FOR ORGAN FAILURE SEVERITY

ABSTRACT

Patients with cirrhosis have a relatively poor prognosis in intensive care (ICU) that could be affected by the9 pandemic. However, the impact of cirrhosis care compared to noncirrhotic patients is unclear pre and post-pandemic. Aim: Define impact of cirrhosis on mortality in ICU patients before & after COVID-19. Methods: ICU pts from a large tertiary hospital who were admitted for >24 hours were divided into pre-COVID (2019) and postpandemic (2020) eras. We excluded patients where cirrhosis diagnosis was unclear. Within the 2020 cohort, we further divided pts into COVID-positive or negative based on PCR. Pts with cirrhosis were matched 11 to non-cirrhotic pts with respect to age, ICU admission qSOFA & ICU length of stay in both cohorts. Reasons for ICU admission, infections, organ failures and discharge information were collected. We first compared only COVID negative cirrhosis vs other pts in the pre and post cohorts & then further compared these within the COVID positive pts. Logistic regression with death/hospice as the outcome was used with cirrhosis status, qSOFA, reason for ICU admission and organ failures as independent variables in the three matched cohorts (pre-COVID, post-COVID positive & post-COVID negative). Finally, to evaluate the relative impact of cirrhosis vs COVID-19, we combined the 2020 cohort and determined death/hospice determinants. Results: We included 200 age/LOS/qSOFA-matched pts with/without cirrhosis in pre-COVID cohort. Post-COVID similarly, 200 pts were included in the COVID negative group. 64 COVID+ pts (with/ without cirrhosis) were also included. More non-cirrhotic pts were admitted for procedural observation & stroke while altered mental status (AMS) were similar. Remaining organ failures were higher in cirrhosis in pre- and post-COVID settings (Table 1). In COVIDpositive pts, cirrhosis had lower infections, respiratory failure and intubation but trended towards higher death. Cirrhosis comparison pre vs post-COVID Post-COVID cirrhosis pts had a higher MELDNa score (15.4±7.9 vs 22.3±10.2, p=0.004)and qSOFA (2.4 vs 1.7, p<0.001) compared to pre-COVID. Logistic regression for death/hospice (Table 2) Pre COVID was significant for cirrhosis, qSOFA , altered mental status & Pressors. Post-COVID in COVID-negative pts it was again significant for cirrhosis, Infection, renal failure & qSOFA. For only COVID positive patients, only renal failure was significant. In the entire 2020 cohort, COVID-19 positive status was not significant in death/hospice prediction, but cirrhosis remained significant. Conclusions: Cirrhosis remains a major cause of mortality in patients admitted to intensive care that continues regardless of COVID-19 pandemic-induced changes in the health system. Cirrhosis is predictive of death independent of COVID-19 despite controlling for demographics and organ failure severity. (Table Presented)