Characteristics and Outcomes of Patients Admitted for Acute Alcoholic Hepatitis Before and During the COVID-19 Pandemic

ABSTRACT

Purpose: Despite known increases in alcohol use, changes in alcohol-associated liver disease rates during COVID-19 have not been well characterized. We compared the incidence and outcomes of hospitalized patients with acute alcoholic hepatitis (AH) before and during COVID-19. Method(s) We identified patients admitted with AH at two tertiary care centers by retrospective chart review in pre-COVID-19 (4/1-6/31/2019) and during COVID-19 (4/1-6/31/2020) time periods using strict criteria (total bilirubin>3.0, AST 35-500, ALT 49-500, and heavy drinking within 60 days of admission). Severe AH was defined as Maddrey's discriminant function (MDF) >= 32. Univariable comparisons were performed using Chi-square and Wilcoxon rank sum tests as appropriate. Result(s) Inpatient admissions for AH increased from 0.13% (90 of 69610) pre- COVID-19 to 0.25% (160 of 63021) during COVID-19 (P<.001). During COVID-19, AH patients had lower rates of polysubstance abuse (40% vs 18%, P<.001) compared to pre-COVID-19 (Table 1). Mental health and substance abuse (MHSA) consult rate was 52% pre- and during COVID-19. Relapse medication use rate was 8% and did not differ significantly between time periods. In severe AH (N=127) frequency of steroid treatment (39% vs 48%, P=0.31), evaluation for (12% vs 16%, P=0.61) or receipt of liver transplant (2% vs 4%, P=1.00) were similar pre- and during COVID-19. Compared to pre-COVID-19, AH patients during COVID-19 had significantly lower rates of all-cause 90-day readmission (59% vs 42%, P=0.02), but there was no difference in rates of 90-day readmission for AH (27% vs 22%, P=0.47), inpatient mortality (11% vs 9%, P=0.66) and 12-month mortality (30% vs 23%, P=0.23). Conclusion(s) Inpatient admission rates for AH nearly doubled during COVID-19. Polysubstance abuse was less common among patients with AH during COVID-19, but 90-day readmission rates remained high pre- and during COVID-19. Low rates of both MHSA consult and relapse medication use indicate a need for greater attention to inpatient alcohol treatment. (Table Presented).