The effect of the COVID-19 pandemic on hospitalizations of cirrhotic patients

Abstract

Introduction

The spread of SARS-CoV-2 has strained the global health system, necessitating a radical reorganization of health resources. In addition, the escalation in liver disease severity among hospitalized COVID-19 patients is a matter of serious concern, as it may lead to the deterioration of health outcomes for a larger population in the future.

Aim

We aimed at providing a comprehensive overview of COVID-19 impact on monthly hospitalization rates, clinical impairment, Length of Stay (LoS), and mortality of cirrhotic patients admitted to the Local Health Board 1 (LHB1) hospitals in the Abruzzo Region, Italy.

Materials and Methods

Using the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM), we identified cases of alcohol-related cirrhosis, nonalcohol-related cirrhosis, and decompensated cirrhosis. We analysed 957 Hospital Discharge Records (HDR) from January 1, 2019, to December 31, 2019 (pre-pandemic), and from January 1, 2022, to December 31, 2022 (post-pandemic) and we evaluated patients' clinical impairment, LoS, and mortality before and after the pandemic.

Results

We identified 494 hospitalizations for nonalcohol-related cirrhosis and 310 for alcohol-related cirrhosis. In the post-pandemic period, hospitalizations for nonalcohol-related cirrhosis significantly decreased (69% vs. 48%; P<.0001), while hospitalizations for alcohol-related cirrhosis significantly increased (31% vs. 52%; P<.0001) compared to pre-pandemic. Additionally, the decompensated patients with alcohol-related cirrhosis significantly increased in the post-pandemic period (77% vs. 65%; P=.0216). Mortality risk significantly increased for both nonalcohol-related (11% vs. 18.5%; P=.0176) and alcohol-related cirrhosis (7.7% vs. 18%; P=.0059) in the post-pandemic era.

Conclusions

Our study pointed out important differences in hospitalization rates and outcomes of cirrhotic patients due to the pandemic, further highlighting the dramatic increase in hospitalizations for alcohol-related cirrhosis. Since this will have a prolonged impact on the natural history of chronic liver disease in Abruzzo Region, continued awareness as well as enhancement of prevention strategies and personalized follow-ups, will be essential.