Trends in Etiology-based Mortality From Chronic Liver Disease Before and During COVID-19 Pandemic in the United States

Kim, Dong‐Hee; Alshuwaykh, Omar; Dennis, Brittany B.; Cholankeril, George; Ahmed, Aijaz

doi:10.1016/j.cgh.2022.05.045

Cited by 31 publications

(40 citation statements)

References 29 publications

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“…This association was independent of age, race, sex, comorbidities, as well as NACSELD-ACLF score. Our data corroborates with outcomes reported by previous studies performed on cohorts and national representative databases [17,18]. Data from several prospective studies has showed that patients with advanced liver disease are at an increased risk of morbidity with COVID-19 infection, including higher risks of hospitalisations, mechanical ventilation and death [19].…”

Section: Discussionsupporting

confidence: 91%

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

et al. 2022

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Patients with co-morbidities like cirrhosis are at risk of worse outcome from COVID-19 infection. Given limited prior studies, we evaluated outcomes associated with COVID-19 infection in alcoholic and non-alcoholic steatohepatitis cirrhotic (CC+) versus cirrhotic without COVID-19 (CC−). We performed retrospective analysis of 822,604 patients including 28,610 COVID-19 patients from the National Inpatient Sample database with alcoholic and NASH cirrhosis enrolled between 1 January 2020 to 31 December 2020, with univariate and multivariate regression analyses. Primary outcome was mortality and secondary outcomes was mechanical ventilation, vasopressor use, length of stay, hospitalization expense and predictors of mortality. In-hospital mortality was three time higher in the CC+ group compared to those in the CC− group(18.6% vs. 5.96%, p < 0.001, adjusted odds ratio (OR)3.39 (95% 3.08–3.74 CI). Hospitalization was more likely for underrepresented racial and ethnic groups with COVID-19 and cirrhosis. CC+ group had over twice the rates of mechanical ventilation (19.92% vs. 9.07%, adjusted OR 2.71 2.71 (95% 2.51–2.93 CI)),1.7 times likelihood of receiving vasopressors (4.12% vs. 2.45%, p < 0.001, adjusted OR 1.71 (95% CI 1.46–2.01). COVID-19 is associated with increased mortality in patients with alcoholic and NASH cirrhosis, and patients with alcoholic cirrhosis and COVID-19 have a slightly higher mortality compared to NASH cirrhosis.

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Section: Discussionsupporting

confidence: 91%

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

et al. 2022

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“…Third, previous articles only evaluated the short early pandemic period, but our study evaluated data obtained up to September 2021. 5,17 Lastly, we provided forecast data predicting mortality rates during the pandemic based on a prior trend from 2012 to 2019 and compared forecasted data with observed rates, thereby helping to quantify the impact of the pandemic on cirrhosis-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Trends of Cirrhosis-related Mortality in the USA during the COVID-19 Pandemic

Yeo¹,

He²,

Lv³

et al. 2022

J Clin Transl Hepatol

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Immunocompromised status and interrupted routine care may render patients with cirrhosis vulnerable to the coronavirus disease 2019 (COVID-19) pandemic. A nationwide dataset that includes more than 99% of the decedents in the U.S. between April 2012 and September 2021 was used. Projected age-standardized mortality during the pandemic were estimated according to prepandemic mortality rates, stratified by season. Excess deaths were determined by estimating the difference between observed and projected mortality rates. A temporal trend analysis of observed mortality rates was also performed in 0.83 million decedents with cirrhosis between April 2012 and September 2021 was included. Following an increasing trend of cirrhosis-related mortality before the pandemic, with a semiannual percentage change (SAPC) of 0.54% [95% confidence interval (CI): (0.0-1.0%), p=0.036], a precipitous increase with seasonal variation occurred during the pandemic (SAPC 5.35, 95% CI: 1.9-8.9, p=0.005). Significantly increased mortality rates were observed in those with alcohol-associated liver disease (ALD), with a SAPC of 8.44 (95% CI: 4.3-12.8, p=0.001) during the pandemic. Allcause mortality of nonalcoholic fatty liver disease rose steadily across the entire study period with a SAPC of 6.79 (95% CI: 6.3-7.3, p<0.001). The decreasing trend of HCV-related mortality was reversed during the pandemic, while there was no significant change in HBV-related deaths. While there was significant increase in COVID-19-related deaths, more than 55% of the excess deaths were the indirect impact of the pandemic. We observed an alarming increase in cirrhosisrelated deaths during the pandemic especially for ALD, with evidence in both direct and indirect impact. Our findings have implications on formulating policies for patients with cirrhosis.

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Section: Predictionsmentioning

confidence: 99%

“… Population-based analyses conducted in the USA determined that mortality due to cirrhosis increased markedly during the COVID-19 pandemic 123 . Evidence from multiple countries has demonstrated that alcohol consumption increased substantially during the pandemic 97 , 124 – 128 , and the observed increase in mortality was mainly related to alcohol-associated cirrhosis 123 . Among patients with COVID-19 and chronic liver disease in the US National COVID Cohort Collaborative, the presence of cirrhosis was associated with an increased risk of mortality (adjusted HR 3.3) 129 .…”

Section: Predictionsmentioning

confidence: 99%

Global epidemiology of cirrhosis — aetiology, trends and predictions

Huang

Terrault

Tacke

et al. 2023

Nat Rev Gastroenterol Hepatol

257

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Cirrhosis is an important cause of morbidity and mortality in people with chronic liver disease worldwide. In 2019, cirrhosis was associated with 2.4% of global deaths. Owing to the rising prevalence of obesity and increased alcohol consumption on the one hand, and improvements in the management of hepatitis B virus and hepatitis C virus infections on the other, the epidemiology and burden of cirrhosis are changing. In this Review, we highlight global trends in the epidemiology of cirrhosis, discuss the contributions of various aetiologies of liver disease, examine projections for the burden of cirrhosis, and suggest future directions to tackle this condition. Although viral hepatitis remains the leading cause of cirrhosis worldwide, the prevalence of non-alcoholic fatty liver disease (NAFLD) and alcohol-associated cirrhosis are rising in several regions of the world. The global number of deaths from cirrhosis increased between 2012 and 2017, but age-standardized death rates (ASDRs) declined. However, the ASDR for NAFLD-associated cirrhosis increased over this period, whereas ASDRs for other aetiologies of cirrhosis declined. The number of deaths from cirrhosis is projected to increase in the next decade. For these reasons, greater efforts are required to facilitate primary prevention, early detection and treatment of liver disease, and to improve access to care.

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Trends in Etiology-based Mortality From Chronic Liver Disease Before and During COVID-19 Pandemic in the United States

Cited by 31 publications

References 29 publications

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

Trends of Cirrhosis-related Mortality in the USA during the COVID-19 Pandemic

Global epidemiology of cirrhosis — aetiology, trends and predictions

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