Changes in Alcohol Use Patterns in the United States During COVID-19 Pandemic.

INTRODUCTION: The novel coronavirus SARS-CoV-2 (COVID-19) has rapidly emerged as a public health emergency. In the United States, "stay-at-home" orders have led to loss of social routines and the closing of restaurants and bars; as a result, sales of alcohol have increased. The aim of this study was to assess changes in alcohol use patterns as a result of social distancing measures. METHODS: A single online survey was sent to a convenience sample of adults through social media. Self-reported demographics and alcohol use patterns before and during social distancing were obtained. RESULTS: Four hundred seventeen subjects completed the survey; 83% were women, 77% were married, 44% were between ages 35 and 44 years. Alcohol Use Disorders Identification Test (AUDIT-C) scores increased from median value of 3 to 4 (P < 0.0001); the increase was statistically significant only in women (P < 0.0001). Fewer people use alcohol during social distancing; however, in those who use alcohol, the frequency and quantity ingested increased, as well as the frequency of alcohol use prior to 5 pm. Despite these increases, there was an overall reduction in binge drinking pattern. Multivariate analysis identified women, having children at home, and a history of substance abuse to be associated with increase in alcohol use. CONCLUSION: Among those who continue to drink alcohol, social distancing has led to a significant increase in the amount of alcohol ingested, frequency of alcohol use, and an increase in AUDIT-C scores in women suggesting hazardous alcohol use behaviors. Clinicians should continue to assess patient alcohol use during the pandemic. Further studies will be needed to assess long-term outcomes after the COVID-19 pandemic resolves.

Gender disparities in liver transplant candidates with nonalcoholic steatohepatitis.

BACKGROUND: Nonalcoholic steatohepatitis (NASH) is the fastest growing indication for liver transplantation (LT). Data from the UNOS database were used to compare rates of listing and LT between men and women with NASH. METHODS: The study population consisted of 76 149 patients listed for LT between 2005 and 2012, 5 492 (7.2%) of who were listed for NASH. Patient characteristics and outcomes were compared by gender. RESULTS: Nonalcoholic steatohepatitis was a more frequent indication for transplant listing in women than men throughout the study period. Women had lower serum creatinine levels at listing (1.18 ± 0.76 mg/dL vs 1.28 ± 0.79 mg/dL, P < .001) and were less likely to be listed with exception points (17.7% vs 24.9%, P < .001). Transplantation was less common among women than men with NASH (52.4% vs 64.3%), and women were more likely to experience death on the waiting list (17.1% vs 11.4%) In multivariable analysis adjusting for covariates, the rate of LT remained lower for women with NASH (aHR 0.81 95% CI: 0.75-0.88). CONCLUSIONS: Women with NASH cirrhosis had a higher risk of death on the LT waiting list and were less likely to receive LT compared to men.

Adverse Effect of Post-Discharge Care Fragmentation on Outcomes after Readmissions after Liver Transplantation.

BACKGROUND: Post-discharge surgical care fragmentation is defined as readmission to any hospital other than the hospital at which surgery was performed. The objective of this study was to assess the impact of fragmented readmissions within the first year after orthotopic liver transplantation (OLT). STUDY DESIGN: The Healthcare Cost and Utilization Project State Inpatient Databases for Florida and California from 2006 to 2011 were used to identify OLT patients. Post-discharge fragmentation was defined as any readmission to a non-index hospital, including readmitted patients transferred to the index hospital after 24 hours. Outcomes included adverse events, defined as 30-day mortality and 30-day readmission after a fragmented readmission. All statistical analyses considered a hierarchical data structure and were performed with multilevel, mixed-effects models. RESULTS: We analyzed 2,996 patients with 7,485 readmission encounters at 299 hospitals; 1,236 (16.5%) readmissions were fragmented. After adjustment for age, sex, readmission reason, index liver transplantation cost, readmission length of stay, number of previous readmissions, and time from transplantation, post-discharge fragmentation increased the odds of both 30-day mortality (odds ratio [OR] = 1.75; 95% CI 1.16 to 2.65) and 30-day readmission (OR = 2.14; 95% CI 1.83 to 2.49). Predictors of adverse events after a fragmented readmission included increased number of previous readmissions (OR = 1.07; 95% CI 1.01 to 1.14) and readmission within 90 days of OLT (OR = 2.19; 95% CI 1.61 to 2.98). CONCLUSIONS: Post-discharge fragmentation significantly increases the risk of both 30-day mortality and subsequent readmission after a readmission in the first year after OLT. More inpatient visits before a readmission and less time elapsed from index surgery increase the odds of an adverse event after discharge from a fragmented readmission. These parameters could guide transfer decisions for patients with post-discharge fragmentation.

Management of Difficult Cases of Autoimmune Hepatitis.

Autoimmune hepatitis (AIH) is a complex autoimmune disease characterized by immune-mediated destruction of hepatic parenchyma which can result in cirrhosis, liver failure, and death. Current American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of Liver (EASL) guidelines recommend corticosteroids alone or in combination with azathioprine as first-line treatment strategies. However, a significant proportion of patients may not be able to tolerate or achieve complete biochemical response with these options. In this article, we discuss approaches to these patients and other challenging AIH patient groups such as the asymptomatic, pregnant, elderly, and liver transplant recipients.