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Mortality Increased Among Hospitalized Patients with Cirrhosis Before and Following Different Waves of the COVID-19
Patrick A Twohig1, Kyle Scholten2, Makayla Schissel3
1Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA. patwohig@gmail.com.
Insights
Inpatient mortality for cirrhosis patients significantly increased during the COVID-19 pandemic. This study highlights the pandemic
Area of Science:
- Hepatology and Gastroenterology
- Infectious Diseases Epidemiology
- Health Services Research
Background:
- The COVID-19 pandemic significantly disrupted healthcare, potentially worsening outcomes for chronic diseases like cirrhosis.
- Limited data exists on the pandemic's specific impact on cirrhosis patient hospitalizations and mortality.
Purpose of the Study:
- To characterize hospitalized cirrhosis patients before and during the COVID-19 pandemic.
- To evaluate inpatient mortality and 30-day readmission rates in this cohort across different pandemic phases.
Main Methods:
- Retrospective single-center cohort study analyzing 33,926 hospitalizations of cirrhosis patients from 2018-2022.
- Pandemic periods defined using WHO and CDC data.
- Logistic regression used to compare outcomes between pre-pandemic and pandemic periods.
Main Results:
- Inpatient mortality was higher during most COVID-19 periods compared to pre-pandemic baseline, except for the Omicron variant period.
- 30-day readmission odds increased by 1.2 times during the pre-vaccination period.
- Demographic shifts observed, including more Hispanic patients hospitalized and decreased Medicare/Medicaid utilization during the pandemic.
Conclusions:
- Inpatient mortality for cirrhosis patients increased during the COVID-19 pandemic.
- Factors beyond direct COVID-19 infection likely contribute to worsened outcomes in this population.
Background:
The Coronavirus disease 2019 (COVID-19) pandemic disrupted patient care and worsened the morbidity and mortality of some chronic diseases. The impact of the COVID-19 pandemic on hospitalizations and outcomes in patients with cirrhosis both before and during different time periods of the pandemic has not been evaluated.
Aims:
Describe characteristics of hospitalized patients with cirrhosis and evaluate inpatient mortality and 30-day readmission before and after the start of the COVID-19 pandemic.
Methods:
Retrospective single-center cohort study of all hospitalized patients with cirrhosis from 2018 to 2022. Time periods within the COVID-19 pandemic were defined using reference data from the World Health Organization and Centers for Disease Control. Adjusted odds ratios from logistic regression were used to assess differences between periods.
Results:
33,926 unique hospitalizations were identified. Most patients were over age 60 years across all time periods of the pandemic. More Hispanic patients were hospitalized during COVID-19 than before COVID-19. Medicare and Medicaid are utilized less frequently during COVID-19 than before COVID-19. After controlling for age and gender, inpatient mortality was significantly higher during all COVID-19 periods except Omicron compared to before COVID-19. The odds of experiencing a 30-day readmission were 1.2 times higher in the pre-vaccination period compared to the pre-COVID-19 period.
Conclusion:
Inpatient mortality among patients with cirrhosis has increased during the COVID-19 pandemic compared to before COVID-19. Although COVID-19 infection may have had a small direct pathologic effect on the natural history of cirrhotic liver disease, it is more likely that other factors are impacting this population.
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