Chronic liver disease, alcohol use disorders contribute to mortality, disease burden in COVID-19

Independent risk factors for COVID-19 mortality included chronic liver disease and alcohol use disorders, which also contributed to disease burden in 2020, according to a presenter at the International Liver Congress.

“Our study has exposed health inequities in our country,” Vincent Mallet, MD, senior physician and professor, hepatology unit, Cochin University, Paris, France, said during his presentation. “We think that a strong message should come from our society to profit from these lessons from this catastrophic disorder and leverage new policies to improve outcomes of our patients including patients with advanced liver disease and patients with alcohol use disorders.”

Mallet and colleagues used data from the French National Hospital Discharged database on 187,283 patients aged 18 years and older who were discharged in the year 2020 with a diagnosis code for Covid-19. They included data from 2011-2020, corresponding, standardized discharge summaries, including demographics, primary and associated discharge diagnosis codes according to the WHO International Classification of Diseases, 10th revision; medical procedures received; length of stay; and discharge modes.

The investigators reported that in 2020, 16,338 patients in France with chronic liver disease were admitted for COVID-19; 3,943 of whom died, including 2,518 after a liver-related complication.

Primary exposure included compensated or advanced chronic liver disease and alcohol use disorders, prior to COVID-19. Mortality, including death after a liver-related complication and overall death, served as the primary outcome. Researchers estimated risk for death at the hospital after COVID-19 with the Charlson comorbidity index and Cox proportional hazards models stratified by age categories, sex, obesity, hypertension.

Of the 10,652 patients diagnosed with alcohol use disorders, 872 died (P < .001), including 472 after a liver-related complication. Investigators reported the adjusted mortality hazard ratios for chronic liver disease was 1.23 (95% CI, 1.1–1.38) and 1.12 (95% CI, 1.07–1.17) for alcohol use disorders.

According to researchers, population attributable fractions of COVID-19 mortality were 2.5% for chronic liver disease and 0.8% for alcohol use disorders.