Infection mitigation during pandemic may have benefited AH patients treated with steroids

Key takeaways:

• Mortality rates were higher among patients with severe alcohol-associated hepatitis treated with corticosteroids in the pre-COVID period.
• Estimated survival probabilities were higher during the pandemic.

BOSTON — Mortality rates were consistently lower in patients with severe alcohol-associated hepatitis treated with steroids during vs. before the COVID-19 pandemic, suggesting infection mitigation may have benefited this population.

“Rising rates of alcohol use disorder and alcohol-associated hepatitis were observed during the COVID pandemic,” Samer Gawrieh, MD, professor of clinical medicine at Indiana University School of Medicine, told Healio. “Infection mitigations measures were widely used and included limited patients contacts with visitors, universal masking and emphasis on hand hygiene.

“Patients with severe AH are usually treated with corticosteroids and are at an increased risk of life-threatening infections. How the infection control measures implemented during the pandemic affected infections and mortality of patients with severe AH was unknown.”

Gawrieh and colleagues combined data from five recent clinical trials, three of which were conducted before the pandemic, one during the pandemic and one in a period before and during the pandemic. They compared mortality rates at 28, 90 and 180 days among 575 patients with severe alcohol-associated hepatitis treated with corticosteroids in the periods before and during the pandemic (415 pre-COVID; 160 during COVID).

Researchers noted that patients recruited during the pandemic were slightly younger than those recruited before COVID (43.7 years vs. 46.5 years), but mean MELD scores were similar between groups (24.8 vs. 25.7).

Results presented at The Liver Meeting showed that mortality rates were consistently higher among patients in the pre-COVID period at days 28 (11.6% vs. 2.5%), 90 (22.4% vs. 10%) and 180 (26.5% vs. 15%).

“In two of the five cohorts included that prospectively collected and reported infection data, the overall rate of all infections was not different,” Gawrieh noted. “But, strikingly, the study done during the pandemic reported no local or systemic fungal infections in these patients.”

After controlling for MELD and other patient characteristics, researchers reported adjusted HRs for survival at 28, 90 and 180 days during the pandemic period were 0.28 (95% CI, 0.1-0.79), 0.51 (95% CI, 0.3-0.87) and 0.57 (95% CI, 0.36-0.89), respectively. They also noted “significantly higher” estimated survival probabilities during this time.

“If confirmed, the findings will present evidence to support infection mitigation measures as an important adjunct to other interventions used to treat and improve the survival of patients with this life-threatening illness,” Gawrieh told Healio. “We are currently collecting detailed infection data on two of the five study cohorts to further validate the findings.”