Increased mortality and decreased registrations in cirrhosis registry during COVID-19 era

Background: Our HEGITO liver unit provides the in- and out-patient (pt) tertiary referral services including liver transplantation (LT) Since 2014, HEGITO has kept registry (RH7) of patients hospitalized with cirrhosis / advanced chronic liver disease (ACLD) The social distancing policy restrictions were introduced in Slovakia on March 16, 2020 and they have substantially changed the usual provision of HEGITO services: We 1 deferred or diverted to telemedicine most of planned and on-demand outpatient services, 2 deferred planned and delimited to region-proper lower-rank institutions acute hospitalizations and, 3 deferred LT except for urgent indications In this study, we aimed to analyze the registrations to and mortality in RH7 pre- and during the COVID-19 era Methods: Using a sample of pt registered to RH7 anytime from its start in 2014 and passing away before March 16, 2020 (PRE-COVID COHORT), we conducted a survival analysis using a Cox proportional hazard model with following factors: gender, age, BMI, CTP, MELD, LFI, ACLF, TSF, DYNAMO, CRP, LEU We used this model to predict individual median residual lifetime for remaining 563 pt from RH7 who were alive at March 16 (COVID COHORT) We compared actual cumulative number of deaths between March 16 and June 6, with predictions based on the Cox PH model Deaths were ascertained by the weekly reports from the Healthcare Surveillance Authority with the special query for COVID 19 code Results: We identified 1091 pt in PRECOVID COHORT with median age 56 8, MELD 16, 60 8% male, and 563 pt in COVID COHORT with median age 55 7, MELD 14, 57 2% male, respectively Registry data shows a significant drop in weekly new registrations to RH7: four in March 2020 vs 17 8 average in March 2014-2019, followed by a sharp increase after these policies were lifted (Figure) Registered mortality in COVID COHORT was higher than mortality predicted by the Cox PH model using PRE-COVID COHORT (28 vs 22) Of note, there was no death related to COVID 19 in the COVID COHORT Conclusion: Analysis of our cirrhosis registry has revealed significantly decreased regsitrations and increased mortality during COVID 19 era We speculate that they are causally related to the impact of the pandemic on the quality of cirrhosis care (Tapper, J Hep 20;73: 441)