Alcoholic hepatitis admissions and disease severity during the COVID-19 (sars-cov-2) pandemic

Background: Alcoholic hepatitis (AH) is an inflammatory liver disease associated with sustained heavy alcohol use. Increased alcohol use during the COVID-19 pandemic has been previously described. Aim: to quantify the change in hospital admissions for AH during the COVID-19 pandemic as compared to previous years. Methods: We included patients admitted at University of California Davis Medical Center from July 2007 to April 2021. The COVID-19 pandemic cohort was defined from February 2020 to April 2021. We included patients who met modified National Institute on Alcohol Abuse and Alcoholism (NIAAA) AH Consortia criteria for probable or definite AH. The primary endpoint was change in AH admissions during the COVID-19 pandemic. Secondary endpoints included severity of illness and development of complications (ascites, bleeding, infection, hepatic encephalopathy). For monthly AH admissions, linear regression was used to test for cohort differences, controlling for total admissions. For secondary endpoints, hierarchical logistic regression models were used to account for multiple visits. Results: 494 patient admissions for AH met inclusion criteria;411 admissions were in the pre-pandemic cohort and 83 admissions were in the pandemic cohort. In the pandemic cohort, 62.7% were male and the mean age was 46.5 years;in the pre-pandemic cohort 61.1% were male and the mean age was 47.3 years (p>0.05). The pandemic cohort had a significantly lower incidence of hepatitis C and pentoxifylline use (p<0.05). There was a linear increase in AH admissions during the study period. During the pandemic there were 1.34 additional monthly AH admissions as compared to the pre-pandemic time period (p=0.0354). However, AH admissions did not increase relatively to increasing overall admissions, indicating that the change in AH admissions was not a consequence of increasing overall admissions. For every 1000 additional patients admitted in a given month, the number of AH admissions decreased by 1.35 (p<0.0001). The pandemic cohort had a trend towards a higher MELD score at admission (23.11 vs 21.16;p=0.0769), with a significantly higher MELD (21.48 vs 19.17;p=0.0288), and MELDNa (24.16 vs 22.1;p=0.032) at discharge. There were no significant differences in length of stay or complications. During the pandemic, there was an increase in in-hospital mortality (OR 1.88;p=0.0935). Of the 68 AH admissions with COVID-19 testing, 2 had positive tests. Conclusion: Our study reveals a significant increase in AH admissions and disease severity during the COVID-19 pandemic, highlighting the direct impact of COVID-19-related social stressors on alcohol use and related complications.