Spotlight on alcoholic hepatitis during the pandemic

Recent studies found increases in patients registering for liver transplants and receiving them, as well as more hospitalizations for alcoholic hepatitis during the COVID-19 pandemic.

Two recent studies focused on trends in alcoholic hepatitis (AH) during the COVID-19 pandemic.

The first study found that waiting list registrations and deceased donor liver transplants for AH increased significantly among U.S. adults during the pandemic. Researchers obtained data from the United Network for Organ Sharing Standard Transplant Analysis and Research file between Jan. 1, 2016, and Jan. 31, 2021, categorizing by diagnosis of AH, alcohol-related cirrhosis, or non-alcohol-associated liver disease (any other diagnosis) and comparing waiting list registrations and deceased donor liver transplantations during COVID-19 (March 2020 to January 2021) versus pre-COVID-19 (March 2019 to January 2020). Results were published Oct. 26 as a research letter by JAMA Network Open.

The researchers assessed 51,488 new waiting list registrations and 32,320 deceased donor liver transplants during the study period. The median age was 58.0 years before and during COVID-19. Among new waiting list registrants, 15,247 (36.1%) were women and 26,930 (63.9%) were men during the pre-COVID-19 period, compared with 3,477 women (37.3%) and 5,834 men (62.7%) during COVID-19 (P=0.03). During the pandemic, there were significant increases in AH diagnoses among the waiting list registrations (2.4% vs. 1.4%; P<0.001) and deceased donor liver transplants (3.0% vs. 1.6%; P<0.001) compared with pre-COVID-19. After briefly decreasing from March to May 2020, volumes of waiting list registrations and deceased donor liver transplants increased sharply, exceeding forecasted values by a mean of 59.5% and 62.0%, respectively. In contrast, trends in waiting list registrations and deceased donor liver transplants for alcohol-related cirrhosis and non-alcohol-associated liver disease remained unchanged. The study was limited by its retrospective nature and the possibility that changes in allocation policy and transplant center practices independently affected the results, the authors noted.

The second study found a significant increase in hospital admissions for AH during the pandemic in Alberta, Canada. Researchers used provincial inpatient discharge and laboratory databases to identify liver-related hospitalizations for non-alcohol-related cirrhosis, alcohol-related cirrhosis, and AH between March 2018 and September 2020. They compared COVID-19 restrictions from April to September 2020 to prior study periods and identified patients with AH by elevated liver enzyme levels, international normalized ratio, or bilirubin. Results were published online on Oct. 26 by Clinical Gastroenterology and Hepatology.

During the study period, there were 2,916 hospitalizations for non-alcohol-related cirrhosis, 2,318 for alcohol-related cirrhosis, and 1,408 for AH. The in-hospital mortality rate was stable during the pandemic for alcohol-related cirrhosis and AH; however, non-alcohol-related cirrhosis patients had lower in-hospital mortality after March 2020 compared to before the pandemic (8.5% vs. 11.5%; P=0.033). There was a significant increase in average monthly admissions in the AH cohort (22.1 vs. 11.6 of 10,000 admissions during the pandemic vs. prior to March 2020; P<0.001), corresponding to about a 10% increase in hospitalizations for AH per month. Patients with AH admitted during versus before the pandemic were younger, had lower rates of comorbidities, had a lower prevalence of hepatitis C, and were more likely to live in a rural area. Among other limitations, Alberta had a low health care burden during the first COVID-19 wave; therefore, its hospitalization trends may differ from those in other areas that were overwhelmed, the study authors noted.

“The concerning increase of AH patients has been expected due to the effect of the pandemic on mental health and acute increases in habitual alcohol consumption. … [T]here is an urgent need for interventions to decrease alcohol use at the population level and secondary prevention measures to reduce advanced liver fibrosis or cirrhosis among patients with high-risk alcohol consumption,” they wrote.