Skip to main content
SpringerLink
Log in

Mortality Increased Among Hospitalized Patients with Cirrhosis Before and Following Different Waves of the COVID-19 Pandemic

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

An Invited Commentary to this article was published on 21 October 2023

Abstract

Background

The Coronavirus disease 2019 (COVID-19) pandemic disrupted patient care and worsened the morbidity and mortality of some chronic diseases. The impact of the COVID-19 pandemic on hospitalizations and outcomes in patients with cirrhosis both before and during different time periods of the pandemic has not been evaluated.

Aims

Describe characteristics of hospitalized patients with cirrhosis and evaluate inpatient mortality and 30-day readmission before and after the start of the COVID-19 pandemic.

Methods

Retrospective single-center cohort study of all hospitalized patients with cirrhosis from 2018 to 2022. Time periods within the COVID-19 pandemic were defined using reference data from the World Health Organization and Centers for Disease Control. Adjusted odds ratios from logistic regression were used to assess differences between periods.

Results

33,926 unique hospitalizations were identified. Most patients were over age 60 years across all time periods of the pandemic. More Hispanic patients were hospitalized during COVID-19 than before COVID-19. Medicare and Medicaid are utilized less frequently during COVID-19 than before COVID-19. After controlling for age and gender, inpatient mortality was significantly higher during all COVID-19 periods except Omicron compared to before COVID-19. The odds of experiencing a 30-day readmission were 1.2 times higher in the pre-vaccination period compared to the pre-COVID-19 period.

Conclusion

Inpatient mortality among patients with cirrhosis has increased during the COVID-19 pandemic compared to before COVID-19. Although COVID-19 infection may have had a small direct pathologic effect on the natural history of cirrhotic liver disease, it is more likely that other factors are impacting this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Middleton P, Hsu C, Lythgoe MP. Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies. BMJ Open Gastroenterol. 2021;8:e000739.

    Article  PubMed  Google Scholar 

  2. Murthy S, Gomersall CD, Fowler RA. Care for critically Ill patients with COVID-19. JAMA. 2020;323:1499–1500.

    Article  PubMed  Google Scholar 

  3. Dorjee K, Kim H, Bonomo E, Dolma R. Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: a comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients. PLoS ONE. 2020;15:e0243191.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Li J, Liu D, Yan J, Tan Y. Reductions in liver cirrhosis hospitalizations during the COVID-19 pandemic. Hepatol Int. 2021;15:213–214.

    Article  PubMed  Google Scholar 

  5. Shaheen AA, Kong K, Ma C et al. Impact of the COVID-19 pandemic on hospitalizations for alcoholic hepatitis or cirrhosis in Alberta, Canada. Clin Gastroenterol Hepatol. 2022;20:e1170–e1179.

    Article  CAS  PubMed  Google Scholar 

  6. Gonzalez HC, Zhou Y, Nimri FM et al. Alcohol-related hepatitis admissions increased 50% in the first months of the COVID-19 pandemic in the USA. Liver Int. 2022;42:762–764.

    Article  CAS  PubMed  Google Scholar 

  7. Mahmud N, Hubbard RA, Kaplan DE, Serper M. Declining cirrhosis hospitalizations in the wake of the COVID-19 pandemic: a national cohort study. Gastroenterology 2020;159:1134–1136.

    Article  CAS  PubMed  Google Scholar 

  8. Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease-what we know on 1st May 2020. Aliment Pharmacol Ther 2020;52:267–275.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Guan WJ, Liang WH, Zhao Y et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Moon AM, Curtis B, Mandrekar P et al. Alcohol-associated liver disease before and after COVID-19-an overview and call for ongoing investigation. Hepatol Commun. 2021;5:1616–1621.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hirode G, Saab S, Wong RJ. Trends in the burden of chronic liver disease among hospitalized US adults. JAMA Netw Open. 2020;3:e201997.

    Article  PubMed  PubMed Central  Google Scholar 

  12. The Nielsen Company. Rebalancing the ‘COVID-19 Effect’ on alcohol sales. Volume 2021, 2020.

  13. Pollard MS, Tucker JS, Green HD Jr. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3:e2022942.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Weerakoon SM, Jetelina KK, Knell G. Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults. Am J Drug Alcohol Abuse. 2021;47:98–106.

    Article  PubMed  Google Scholar 

  15. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. BMJ 2018;362:k2817.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Deutsch-Link S, Jiang Y, Peery AF et al. Alcohol-associated liver disease mortality increased from 2017 to 2020 and accelerated during the COVID-19 pandemic. Clin Gastroenterol Hepatol 2022;20:2142–2144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bajaj JS, Garcia-Tsao G, Biggins SW et al. Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Gut 2021;70:531–536.

    Article  CAS  PubMed  Google Scholar 

  18. Kim D, Adeniji N, Latt N et al. Predictors of outcomes of COVID-19 in patients with chronic liver disease: US multi-center study. Clin Gastroenterol Hepatol 2021;19:1469–1479.

    Article  CAS  PubMed  Google Scholar 

  19. Da BL, Im GY, Schiano TD. Coronavirus disease 2019 hangover: a rising tide of alcohol use disorder and alcohol-associated liver disease. Hepatology 2020;72:1102–1108.

    Article  CAS  PubMed  Google Scholar 

  20. Cooper S, Tobar A, Konen O et al. Long COVID-19 liver manifestation in children. J Pediatr Gastroenterol Nutr 2022;75:244–251.

    Article  CAS  PubMed  Google Scholar 

  21. Milic J, Barbieri S, Gozzi L et al. Metabolic-associated fatty liver disease is highly prevalent in the postacute COVID syndrome. Open Forum Infect Dis 2022;9:ofac003.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Vergara M, Cleries M, Vela E et al. Hospital mortality over time in patients with specific complications of cirrhosis. Liver Int 2013;33:828–833.

    Article  PubMed  Google Scholar 

  23. Ioannou GN, Liang PS, Locke E et al. Cirrhosis and severe acute respiratory syndrome coronavirus 2 infection in US veterans: risk of infection, hospitalization, ventilation, and mortality. Hepatology 2021;74:322–335.

    Article  CAS  PubMed  Google Scholar 

  24. Moon AM, Webb GJ, Aloman C et al. High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: preliminary results from an international registry. J Hepatol 2020;73:705–708.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Chakrabarti A, Osborne NH, Rangnekar AS et al. The effect of hospital characteristics on racial/ethnic variation in cirrhosis mortality. J. Racial Ethnic Health Disparities 2017;4:243–251.

    Article  Google Scholar 

  26. Nanchal R, Patel D, Guddati AK et al. Outcomes of Covid 19 patients-are hispanics at greater risk? J Med Virol 2022;94:945–950.

    Article  CAS  PubMed  Google Scholar 

  27. Longcoy J, Patwari R, Hasler S et al. Racial and ethnic differences in hospital admissions of emergency department COVID-19 patients. Med Care 2022;60:415–422.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jacobson M, Chang TY, Shah M et al. Racial and ethnic disparities in SARS-COV-2 testing and COVID-19 outcomes in a medicaid managed care cohort. AJPM 2021;61:644–651.

    Google Scholar 

  29. Arvaniti V, D’Amico G, Fede G et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139:1246–1256.

    Article  PubMed  Google Scholar 

  30. Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014;61:1385–1396.

    Article  CAS  PubMed  Google Scholar 

  31. Griffith DM, Sharma G, Holliday CS et al. Men and COVID-19: a biopsychosocial approach to understanding sex differences in mortality and recommendations for practice and policy interventions. Prev Chronic Dis 2020;17:200247.

    Article  Google Scholar 

  32. Nair R, Lak H, Hasan S et al. Reducing all-cause 30-day hospital readmissions for patients presenting with acute heart failure exacerbations: a quality improvement initiative. Cureus 2020;12:e7420.

    PubMed  PubMed Central  Google Scholar 

  33. Ziaeian B, Fonarow GC. The prevention of hospital readmissions in heart failure. Prog Cardiovasc Dis 2016;58:379–385.

    Article  PubMed  Google Scholar 

  34. Garg SK, Goyal H, Obaitan I et al. Incidence and predictors of 30-day hospital readmissions for liver cirrhosis: insights from the United States National Readmissions Database. Ann Transl Med 2021;9:1052.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

None.

Funding

The authors have no grants or financial support to acknowledge or disclose in the development of this article.

Author information

Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA

    Patrick A. Twohig, Mark Mailliard & Thoetchai Bee Peeraphatdit

  2. Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA

    Kyle Scholten, Kevin Brittan & Jason Barbaretta

  3. Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA

    Makayla Schissel, Kaeli Samson & Lynette Smith

Authors
  1. Patrick A. Twohig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyle Scholten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Makayla Schissel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kevin Brittan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Barbaretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaeli Samson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lynette Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mark Mailliard
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Thoetchai Bee Peeraphatdit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick A. Twohig.

Ethics declarations

Conflict of interest

All authors report no conflicts of interest.

Ethical approval

This study was approved by the University of Nebraska Medical Center Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

An editorial commenting on this article is available at https://doi.org/10.1007/s10620-023-08106-w.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Twohig, P.A., Scholten, K., Schissel, M. et al. Mortality Increased Among Hospitalized Patients with Cirrhosis Before and Following Different Waves of the COVID-19 Pandemic. Dig Dis Sci 68, 4381–4388 (2023). https://doi.org/10.1007/s10620-023-08105-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-08105-x

Keywords

Search

Navigation