Alcohol-associated hepatitis admission ‘dramatically’ increased in first year of COVID

There was an 81% increase in alcohol-associated hepatitis admissions within the first year of the COVID-19 pandemic and resulted in a significant increase in liver transplantation, according to a presentation.

“During the pandemic, we observed an uptick in [alcohol-associated hepatitis] admission among all patients and a significant increase in monthly admissions among young adults,” Reid Grinspoon, MD, of Harvard Medical School, said during the presentation at The Liver Meeting Digital Experience.

“Thirty-nine percent of the [alcohol-associated hepatitis] admissions in pandemic year 1, with clear reason for increased drinking, cite a pandemic-related factor.”

Grinspoon and colleagues used the Mass General Brigham research patient data registry to identify patients admitted with a diagnosis of alcohol-associated hepatitis from Jan. 1, 2010, to March 9, 2021. Investigators performed chart review and identified 3,038 charts, of which they reviewed 1,200 patients. They included 157 admissions with alcoholic-associated hepatitis listed as main issue in the discharge summary. 

After Grinspoon and colleagues manually reviewed each identified medical record, they found 583 admissions with a ‘primary hospital problem of alcohol-associated hepatitis’ as stated in the discharge summaries. There were 162 admissions with patients aged 40 years or younger, 421 admissions with patients aged older than 40 years. Additionally, they performed a subgroup analysis in 397 admissions with patients with severe alcohol-associated hepatitis.

Grinspoon and colleagues recorded demographic information, length of stay and whether the patient was treated in the ICU, underwent liver transplantation or died. In addition, they determined MELD, MELD-serum sodium (MELD-Na) and Maddrey’s Discriminant Function (MDF) scores.

Investigators considered March 10, 2020, to March 9, 2021, as the first year of the COVID-19 pandemic and the 4 years prior were the control period. They compared admission characteristics between the two periods.

Investigators noted there were 49 admissions in the first year of the pandemic compared with an average of 27 admissions per year in the control period (P = .004). In the first year of the pandemic, 10.2% of alcohol-associated hepatitis admission culminated in liver transplantation under stringent criteria compared with an average of 1.4% per year in the control period (P = .009).

According to Grinspoon, no significant differences were noted in the first year of the pandemic group compared with the control group with regard to the percentage of patients with alcohol-associated hepatitis who were white (74.5% vs. 84.1%), Hispanic (18.2% vs. 17.8%), female (51% vs. 42.1%), treated in the ICU (36.7% vs. 27.6%) or died (10.2% vs. 12.6%).

Additionally, no significant differences were noted in the first year of the pandemic period vs. control period with regard to the average length of stay (12.7 days vs. 11.6 days), MELD (27.2 vs. 25.8), MELD-Na (29.1 vs. 26.7) or MDF (65.3 vs. 65.3) scores.

“More research is needed to quantify the effects of the pandemic on alcohol-associated liver disease, especially in young people,” Grinspoon concluded.