P0919 - Retrospective Analyses of the Outcomes Among Hospitalized Liver Cirrhosis Patients, Including Those With COVID-19 Infection

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Parth M. Patel, MD (he/him/his)

Henry Ford Health System
Boston, MA

Parth M. Patel, MD¹, Zarqa Yasin, MD², Hassan Zreik, MD³, Harjinder Singh, MD², Bipneet Singh, MD², Parneet Hari, MD⁴, Raffi Karagozian, MD¹
¹Tufts Medical Center, Boston, MA; ²Henry Ford Health, Jackson, MI; ³Henry Ford Health System, Jackson, MI; ⁴Henry Ford Jackson, Jackson, MI

Introduction: Liver cirrhosis (LC) patients are at a higher risk of adverse events associated with Coronavirus disease 2019 (COVID-19). However, studies, especially large population-based reports of the impact of COVID-19 on patients hospitalized with cirrhosis, are limited.

Methods: The National Inpatient Sample database was used for a retrospective analysis of patients with liver cirrhosis admitted during 2020 in the United States (US), with and without a diagnosis of COVID-19, based on ICD-10-CM. We investigated the outcomes of hospitalized LC patients with and without COVID-19 infection, looking at its impact on in-hospital mortality, the risk for acute kidney injury (AKI), and length of stay (LOS). A multivariable logistic regression analysis included various independent variables, including age, sex, race, comorbidities, in-hospital complications, socioeconomic factors, primary expected payer, hospital region, relative bed size category, and location/teaching status of the hospital. The analysis results are presented as adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CI) and p-values to assess the significance of each factor.

Results: Our database of inpatient admissions in 2020 included 6,471,165 patients, of which 157,421 (2.4%) had a diagnosis of LC. Of those with LC, 5197 (3.3%) were also diagnosed with COVID-19. COVID-19-positive LC patients had a higher prevalence of hyponatremia (27.3%). Most importantly, COVID-19-positive LC patients were found to have a significantly higher mortality rate during hospitalization (19.4%) compared to COVID-19-negative patients (6.1%). Multivariable logistic regression models showed that age at admission was significantly associated with inpatient mortality among LC patients (p < 0.001). For each year increase in age, the odds of mortality increased by approximately 1.9%. Several comorbidities were significantly associated with inpatient mortality. Notable factors with increased odds of mortality in LC patients included malnutrition (AOR: 1.424, p < 0.001), COVID-19 (AOR: 3.883, p < 0.001), and acute kidney injury (AOR: 6.067, p < 0.001).

Discussion: Concomitant COVID-19 infection among hospitalized LC patients was associated with a higher risk for in-hospital mortality. COVID-19-positive LC patients had a higher prevalence of hyponatremia. Several comorbidities were significantly associated with inpatient mortality. Notable factors with increased odds of mortality in LC patients included malnutrition, COVID-19, and AKI.

		COVID -ve			COVID +ve			P value
		Median (IQR)	Count	Column %	Median (IQR)	Count	Column %	P value
Age in years at admission		61 (52-69)			63 (54-72)			< 0.001
Indicator of sex	Male		90173	59.2%		3145	60.5%	0.034
Indicator of sex	Female		62047	40.8%		2052	39.5%	0.034
Race (uniform)	White		100755	67.6%		2560	50.5%	< 0.001
	Black		15228	10.2%		616	12.1%
	Hispanic		23190	15.6%		1417	27.9%
	Asian or Pacific Islander		3045	2.0%		119	2.3%
	Native American		2661	1.8%		143	2.8%
	Other		4215	2.8%		219	4.3%
Comorbidities
Hyponatremia			39043	25.6%		1417	27.3%	0.009
Malnutrition			21938	14.4%		599	11.5%	< 0.001
Hypertension			47616	31.3%		1633	31.4%	0.831
Hyperlipidemia			41959	27.6%		1582	30.4%	< 0.001
Obesity			26646	17.5%		1085	20.9%	< 0.001
COPD			22886	15.0%		420	8.1%	< 0.001
CAD			25881	17.0%		885	17.0%	0.970
CKD			30492	20.0%		1074	20.7%	0.267
ERD			9457	6.2%		433	8.3%	< 0.001
Tobacco Use			2153	1.4%		48	0.9%	0.003
Diabetes			18581	12.2%		771	14.8%	< 0.001
In Hospital Complication
Acute Kidney Injury			48783	32.0%		1900	36.6%	< 0.001
Median household income national quartile for patient ZIP Code	0-25^th		49664	33.5%		1943	38.5%	< 0.001
	26^th-50^th		41415	28.0%		1296	25.7%
	51^st– 75^th		32916	22.2%		1021	20.2%
	76^th to 100^th		24046	16.2%		785	15.6%
Primary expected payer (uniform)	Medicare		71387	47.0%		2620	50.5%	< 0.001
	Medicaid		38487	25.3%		1257	24.2%
	Private Insurance		28466	18.7%		887	17.1%
	Self-Pay		8231	5.4%		212	4.1%
	No charge		696	0.5%		12	0.2%
	Other		4756	3.1%		198	3.8%
Hospital Characteristics
Region of hospital	Northeast		24846	16.3%		923	17.8%	0.002
	Midwest		31010	20.4%		1075	20.7%
	South		61440	40.4%		1974	38.0%
	West		34928	22.9%		1225	23.6%
Relative bed size category of hospital (STRATA)	Small		31540	20.7%		1044	20.1%	0.190
	Medium		42679	28.0%		1514	29.1%
	Large		78005	51.2%		2639	50.8%
Location/teaching status of hospital (STRATA)	Rural		11140	7.3%		336	6.5%	0.001
	Urban Nonteaching		27032	17.8%		854	16.4%
	Urban Teaching		114052	74.9%		4007	77.1%
Died during hospitalization			9290	6.1%		1007	19.4%	< 0.001
Total			152023	100.0%		5186	100.0%

Table: Comparison of Sociodemographic and Clinical Characteristics of the COVID Positive and Negative Liver Cirrhosis Patients

Disclosures:

Parth Patel indicated no relevant financial relationships.

Zarqa Yasin indicated no relevant financial relationships.

Hassan Zreik indicated no relevant financial relationships.

Harjinder Singh indicated no relevant financial relationships.

Bipneet Singh indicated no relevant financial relationships.

Parneet Hari indicated no relevant financial relationships.

Raffi Karagozian indicated no relevant financial relationships.

Parth M. Patel, MD¹, Zarqa Yasin, MD², Hassan Zreik, MD³, Harjinder Singh, MD², Bipneet Singh, MD², Parneet Hari, MD⁴, Raffi Karagozian, MD¹. P0919 - Retrospective Analyses of the Outcomes Among Hospitalized Liver Cirrhosis Patients, Including Those With COVID-19 Infection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.