COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

Abstract

Patients with co-morbidities like cirrhosis are at risk of worse outcome from COVID-19 infection. Given limited prior studies, we evaluated outcomes associated with COVID-19 infection in alcoholic and non-alcoholic steatohepatitis cirrhotic (CC+) versus cirrhotic without COVID-19 (CC−). We performed retrospective analysis of 822,604 patients including 28,610 COVID-19 patients from the National Inpatient Sample database with alcoholic and NASH cirrhosis enrolled between 1 January 2020 to 31 December 2020, with univariate and multivariate regression analyses. Primary outcome was mortality and secondary outcomes was mechanical ventilation, vasopressor use, length of stay, hospitalization expense and predictors of mortality. In-hospital mortality was three time higher in the CC+ group compared to those in the CC− group(18.6% vs. 5.96%, p < 0.001, adjusted odds ratio (OR)3.39 (95% 3.08–3.74 CI). Hospitalization was more likely for underrepresented racial and ethnic groups with COVID-19 and cirrhosis. CC+ group had over twice the rates of mechanical ventilation (19.92% vs. 9.07%, adjusted OR 2.71 2.71 (95% 2.51–2.93 CI)),1.7 times likelihood of receiving vasopressors (4.12% vs. 2.45%, p < 0.001, adjusted OR 1.71 (95% CI 1.46–2.01). COVID-19 is associated with increased mortality in patients with alcoholic and NASH cirrhosis, and patients with alcoholic cirrhosis and COVID-19 have a slightly higher mortality compared to NASH cirrhosis.

SARS-CoV-2 Infection Is an Independent Risk Factor for Decompensation in Cirrhosis Patients

“…Additionally, elevated aminotransferase levels at the time of admission also correlate with higher mortality [ 2 , 18 ]. Patients with underlying chronic liver disease were of particular interest, as patients with cirrhosis were noted to have worse outcomes with concomitant SARS-CoV-2 infections [ 1 , 2 , 16 , 19 , 20 , 21 ].…”

“…SARS-CoV-2 infection is associated with a variety of gastrointestinal manifestations. Patients with cirrhosis are particularly interesting, as there is emerging data that cirrhotic patients have an increased mortality rate with SARS-CoV-2 [ 1 ]. Mortality rates have also been noted to increase in patients with decompensated cirrhosis (when compared to compensated disease) and increase with the rising Model for End-Stage Liver Disease (MELD) score or Child–Pugh classification.…”

COVID-19 waves in an urban setting 2020–2022: an electronic medical record analysis

“…The effect of COVID-19 on STEMI ( 32 ) and stoke ( 33 ) outcomes have also been demonstrated, resulting in higher in-patient mortality, length of stay and cost of hospitalization. Kapuria et al found that patients with COVID-19 and cirrhosis had 3 times higher mortality than those without COVID-19 ( 34 ) and Pal et al found sex and racial disparities in hospitalizations and in rates of adverse outcomes ( 35 ).…”

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…Because of its worldwide significance and potential complications, ALD is often considered as a condition that might be exacerbated in the course of various newly developed medical conditions [198]. Infection with SARS-CoV-2 is the ideal example of such occurrences [199][200][201]. Of note, according to a meta-analysis, since the beginning of COVID-19 pandemic, ALD has been indicated as the most common reason for listing for and the fastest increasing cause of liver transplantation (LT) [202].…”