Summary Background Patients with pre‐existing cirrhosis and COVID‐19 may have a poor prognosis. Aim To evaluate the temporal trends in aetiology‐based hospitalisations and potential predictors of in‐hospital mortality during hospitalisation with cirrhosis before and during the COVID‐19 pandemic. Methods Based on the US National Inpatient Sample 2019–2020, we determined quarterly trends in aetiology‐based hospitalisations with cirrhosis and decompensated cirrhosis, and identified predictors of in‐hospital mortality during hospitalisation with cirrhosis. Results We analysed 316,418 hospitalisations, representing 1,582,090 hospitalisations with cirrhosis. Hospitalisations for cirrhosis increased at a relatively higher rate during the COVID‐19 era. Hospitalisation rates for alcohol‐related liver disease (ALD)‐related cirrhosis increased significantly (quarterly percentage change [QPC]: 3.6%, 95% CI: 2.2%–5.1%), with a notably higher rate during the COVID‐19 era. In contrast, hospitalisation rates for hepatitis C virus (HCV)‐related cirrhosis decreased steadily with a trend of −1.4% of QPC (95% CI: −2.5% to −0.1%). Quarterly trends in the proportion of ALD‐ (QPC: 1.7%, 95% CI: 0.9%–2.6%) and nonalcoholic fatty liver disease‐related (QPC: 0.7%, 95% CI: 0.1%–1.2%) hospitalisations with cirrhosis increased significantly but declined steadily for viral hepatitis. The COVID‐19 era and COVID‐19 infection were independent predictors of in‐hospital mortality during hospitalisation with cirrhosis and decompensated cirrhosis. Compared with HCV‐related cirrhosis, ALD‐related cirrhosis was associated with a 40% higher risk of in‐hospital mortality. Conclusion In‐hospital mortality in cirrhosis was higher in the COVID‐19 era than in the pre‐COVID‐19 era. ALD is the leading aetiology‐specific cause of in‐hospital mortality in cirrhosis with an independent detrimental impact of COVID‐19 infection.

We studied the trends in liver cancer‐related mortality before and during the COVID‐19 pandemic. Quarterly age‐standardized mortality and quarterly percentage change (QPC) for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) were estimated using the US national mortality database 2017–2021. Quarterly age‐standardized mortality from HCC decreased steadily with an average QPC of −0.4% (95% confidence interval [CI]: −0.6% to −0.2%). A decrease in hepatitis C virus and hepatitis B virus‐related HCC mortality of −2.2% (95% CI: −2.4% to −1.9%) and −1.1% (95% CI: −2.0% to −0.3%) was noted. In contrast, mortality for HCC from nonalcoholic fatty liver disease (3.0%, 95% CI: 2.0%–4.0%) and alcohol‐related liver disease (1.3%, 95% CI: 0.8%–1.9%) demonstrated a linear increase. There was a linear increase in the quarterly age‐standardized ICC‐related mortality (0.8%, 95% CI: 0.5%–1.0%). While ICC‐related mortality continued to increase, HCC‐related mortality tended to decline mainly due to a decline in mortality due to viral hepatitis.

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LINKED CONTENTThis article is linked to Toyoda et al papers. To view these articles, visit https://doi.org/10.1111//apt.17088 and https://doi.org/10.1111/apt.17361