COVID-19 increases the mortality rates of patients with ALD

An analysis of 25,721 patients with alcohol-related liver disease (ALD) including 16,813 patients before and 11,625 during the pandemic, showed a staggering rise in 60-day and 90-day mortality rates during the pandemic. This was especially pronounced in younger patients and men.

Stress related to the COVID-19 pandemic could lead to excessive alcohol use, which can be further aggravated by isolation-related boredom, shifted medical resources, and limited access to mental health care. Hence, a proper analysis of whether the COVID-19 pandemic has had any effect on the rates of patients with ALD is a crucial aspect of further health planning.

In the analysis conducted by Dr Yee Hui Yeo (Cedars-Sinai Medical Center, CA, USA), Dr Biyao Zou and Dr Mindie H. Nguyen (Stanford University, CA, USA), a total of 25,721 patients with ALD admitted to the emergency department or as an inpatient, including 16,813 patients before and 11,625 during the pandemic, were identified through data obtained from the Optum Clinformatics DataMart database, a source of the Population Health Science Center at Stanford University [1].

During the pre-pandemic period, there were no significant trends in mortality. A downward trend was detected in both 60-day and 90-day mortality rates between the first quarter (Q1) and the third quarter (Q3) of 2019, however, this trend turned upwards during the last quarter (Q4) of 2019 and Q1 of 2020. The pandemic phase was considered to be between Q2 of 2020 to Q1 of 2021. During this time period, a consistent upward trend was present in both the 60-day and 90-day mortality rates. Moreover, by the end of 2020, at least 25% of patients with ALD died by 90 days and 20% died within 60 days after their diagnosis.

The odds of death for ALD surged (18.73; P<0.01) during the pandemic onset in Q2 of 2020 compared with slightly declining rates (0.995; P<0.01) during the pre-pandemic phase. A quarterly comparison between 2020 and 2019 showed that the prevalence ratio in 60-day and 90-day mortality rates of ALD significantly increased for all quarters. For example, the 60-day mortality rate in Q2 of 2020 was 45% higher than in Q2 of 2019.

The increasing trend was more prominent in patients younger than 65 years. Men had a higher gradient of an increasing trend than women. Also, racial differences were observed: while there was no significant change in the prevalence of ALD among non-Hispanic Asians, the upward trend among non-Hispanic Whites and Blacks was significant.

The researchers concluded that during the pandemic an alarming rise was observed in mortality rates in patients with ALD and that more targeted interventions and resource allocation to curb the surging burden of ALD was necessary, with special emphasis on mental health services and alcohol treatment programs.

1. Yeo YH, et al. Prevalence and mortality of Alcohol-related Liver diseases during COVID-19 pandemic. Poster Mo1336, Digestive Disease Week 2022, 21‒24 May, San Diego, CA, USA.

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Posted on 14 June 202226 July 2024