Accelerated impact of alcohol-associated hepatitis on healthcare utilisation during the COVID-19 pandemic

Alcohol-associated hepatitis (AAH) causes significant morbidity, mortality and healthcare expenditure. Increased alcohol consumption during the SARS-CoV-2 (COVID-19) pandemic was observed globally.

This study aims to assess temporal associations between the COVID-19 pandemic and AAH admission frequency and outcomes.

Retrospective cohort study of inpatients aged ≥18 years fulfilling National Institute of Alcohol Abuse and Alcoholism diagnostic criteria for AAH from three Australian tertiary referral hospitals. AAH admissions and outcomes between 1 March 2020 and 31 March 2021 ('COVID-19 cohort') were compared with a 'historical cohort' (1 January 2016-29 February 2020). The primary endpoint was the monthly rate of AAH admissions according to the COVID-19 timepoint. Secondary outcomes included change in AAH severity, interventions and healthcare costs.

In the study period, 301 eligible AAH admissions were identified. The COVID-19 cohort (n = 104) had a significantly higher median AAH monthly admission rate (8 (interquartile range (IQR) 6, 9) vs 3 (3, 5), P < 0.0001) and proportion requiring intensive care unit admission (26% (n = 27) vs 12% (n = 24), P = 0.002), despite similar median MELD-Na scores (20 (IQR 15, 25.5) vs 19 (14, 25), P = 0.24) to the historical cohort (n = 197). Higher median monthly healthcare costs were identified in the COVID-19 cohort ($90 912 (IQR 43 853, 243 469) vs $42 983 (IQR 18 231, 71 410), P = 0.03). Ninety-day mortality was 14%. No patients were diagnosed with COVID-19.

In this multicentre analysis, AAH admission frequency, ICU requirement and healthcare costs increased during the COVID-19 pandemic. These observations provide the impetus for future studies to help develop preventive strategies that reduce alcohol-related admissions.