Trends in aetiology‐based hospitalisation for cirrhosis before and during the COVID‐19 pandemic in the United States

Abstract

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.

Editorial: Alcohol‐related liver disease is the primary driver of cirrhosis‐related hospital admissions in the COVID‐19 era—What can be done?

“…In their recent study, Kim et al, 6 Using a validated case definition for cirrhosis, their study identified an increase in-hospital mortality during the pandemic to 6.6% as compared to 5.6% pre-pandemic. This increase was largely driven by alcohol-related liver disease, that experienced a quarterly percentage increase in hospitalisations of 3.6%.…”

“…In their recent study, Kim et al, 6 used the US‐based National Inpatient Sample (NIS), a large population‐based dataset, to explore quarterly temporal trends in cirrhosis hospitalisations and mortality based on cirrhosis aetiology from 2019 to 2020 to try and offer further clarity regarding COVID‐19's impact on this population. Using a validated case definition for cirrhosis, their study identified an increase in‐hospital mortality during the pandemic to 6.6% as compared to 5.6% pre‐pandemic.…”

“…The methodologically vigorous study by Kim et al, 6 adds to the literature showing an increase in mortality in patients with cirrhosis during the pandemic 1 and additionally provides aetiology‐based hospitalisation trends. As COVID‐19 transitions to endemic status, it will be interesting to see if these trends remain, and how some of the authors' proposed interventions will impact the epidemiology of cirrhosis‐related hospitalisations and mortality.…”

The Impact of Alcohol Consumption and Addiction on Liver Transplantation Programs in the COVID-19 Era

“… Increases in rates of admissions for females far higher than for males. Kim et al 2023 16 USA Cross-sectional national database – National Inpatient Sample 316,418 hospitalizations for cirrhosis Hospitalization rates for ALD increased significantly (quarterly percentage change: 3.6%, 95% CI: 2.2–5.1%), with a notably higher rate during the COVID-19 era. COVID-19 era and COVID-19 infection were independent predictors of in-hospital mortality during hospitalization with cirrhosis and decompensated cirrhosis.…”

“… 15 Hospitalization rates for ALD-related cirrhosis increased significantly (quarterly percentage change: 3.6%, 95% confidence interval [CI]: 2.2%–5.1%), with a notably higher rate during the COVID-19 era. 16 Liver transplant centers in the United States also manage higher numbers of referrals for severe ALD with recent unhealthy drinking, defined as drinking within the past six months. 17 Concerningly, mortality rates in patients with ALD admitted to hospitals in the United States already appear to be rising.…”