Background & Aims

Coronavirus disease 2019 (COVID-19) pandemic lockdown and restrictions had significant disruption to patient care. We aimed to evaluate the impact of COVID-19 restrictions on hospitalizations of patients with alcoholic and nonalcoholic cirrhosis as well as alcoholic hepatitis (AH) in Alberta, Canada.

Methods

We used validated International Classification of Diseases (ICD-9 and ICD-10) coding algorithms to identify liver-related hospitalizations for nonalcoholic cirrhosis, alcoholic cirrhosis, and AH in the province of Alberta between March 2018 and September 2020. We used the provincial inpatient discharge and laboratory databases to identify our cohorts. We used elevated alanine aminotransferase or aspartate aminotransferase, elevated international normalized ratio, or bilirubin to identify AH patients. We compared COVID-19 restrictions (April–September 2020) with prior study periods. Joinpoint regression was used to evaluate the temporal trends among the 3 cohorts.

Results

We identified 2916 hospitalizations for nonalcoholic cirrhosis, 2318 hospitalizations for alcoholic cirrhosis, and 1408 AH hospitalizations during our study time. The in-hospital mortality rate was stable in relation to the pandemic for alcoholic cirrhosis and AH. However, nonalcoholic cirrhosis patients had lower in-hospital mortality rate after March 2020 (8.5% vs 11.5%; P = .033). There was a significant increase in average monthly admissions in the AH cohort (22.1/10,000 admissions during the pandemic vs 11.6/10,000 admissions before March 2020; P < .001).

Conclusions

Before and during COVID-19 monthly admission rates were stable for nonalcoholic and alcoholic cirrhosis; however, there was a significant increase in AH admissions. Because alcohol sales surged during the pandemic, future impact on alcoholic liver disease could be detrimental.

中文翻译：

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COVID-19 大流行对加拿大艾伯塔省酒精性肝炎或肝硬化住院的影响

背景与目标

2019 年冠状病毒病 (COVID-19) 大流行封锁和限制严重干扰了患者护理。我们旨在评估 COVID-19 限制对加拿大阿尔伯塔省酒精性和非酒精性肝硬化以及酒精性肝炎 (AH) 患者住院治疗的影响。

方法

我们使用经过验证的国际疾病分类（ICD-9 和 ICD-10）编码算法来识别 2018 年 3 月至 2020 年 9 月期间阿尔伯塔省因非酒精性肝硬化、酒精性肝硬化和 AH 与肝脏相关的住院治疗。我们使用了省内住院患者出院和实验室数据库以确定我们的队列。我们使用升高的谷丙转氨酶或天冬氨酸转氨酶、升高的国际标准化比率或胆红素来识别 AH 患者。我们将 COVID-19 限制（2020 年 4 月至 9 月）与之前的研究期进行了比较。连接点回归用于评估 3 个队列之间的时间趋势。

结果

在我们的研究期间，我们确定了 2916 例非酒精性肝硬化住院、2318 例酒精性肝硬化住院和 1408 例 AH 住院。与酒精性肝硬化和 AH 的流行相关，院内死亡率保持稳定。然而，非酒精性肝硬化患者在 2020 年 3 月之后的院内死亡率较低（8.5% 对 11.5%；P  = .033）。AH 队列的平均每月入院人数显着增加（大流行期间入院人数为 22.1/10,000，而 2020 年 3 月之前为 11.6/10,000；P <.001）。

结论

在 COVID-19 之前和期间，非酒精性和酒精性肝硬化的月入院率稳定；但是，AH 录取人数显着增加。由于大流行期间酒精销量激增，未来对酒精性肝病的影响可能是有害的。