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Alcoholic hepatitis during the COVID-19 pandemic: Results from a multi-center health network

Background: During the COVID-19 pandemic, alcohol use and alcohol use disorders significantly increased. We evaluated the prevalence of alcoholic hepatitis (AH) in hospitalized patients without established cirrhosis during the pandemic across a multi-center health network in relation to gender, ethnicity, MELD score, Maddrey score, and portal hypertensive complications. Methods: Adult admissions for AH in non-cirrhotic patients were evaluated in the Phoenixarea within a single multi-center health network both during the pandemic (3/1/2020-12/31/2020) and compared against the same 9 months in 2019. AH and cirrhosis codes were identified via ICD-10 codes. Patients with a transaminase pattern on admission not consistent with AH, and those on dialysis or warfarin were excluded. Students t-test or Mann-Whitney test and Chi-Square or Fisher Exact test were used to compare continuous and categorical variables respectively. Poisson regression was used to compare the alcoholic hepatitis admission rates between the two periods. Results: 296 patients met the inclusion criteria during the pandemic, compared to 225 patients in 2019. The percentage of hospitalization for AH during the pandemic period compared to 2019 increased by 32% (1.7-2.3/1000, p=0.001). We did not see a difference in age or gender, but we did find a notable increase in Hispanic and Native American (NA) admissions from 0.9-1.8/1000 (p=0.002) and 9.2-13.5/1000 respectively (p=0.09). The majority of patients had biochemically nonsevere AH across both time periods (Table 1). MELD score, number of patients with a Maddrey score greater or less than 32, steroid use, portal hypertensive complications, length of stay (LOS) and mortality were also similar in both periods (Table 1). Across both time periods, we noted very few consults for Addiction Medicine and Palliative Medicine (Table 1). 3 patients were COVID positive during the same encounter for AH. Conclusion: There was a significant rise in the proportion of patients admitted for AH during the pandemic, disproportionately affecting Hispanic patients and possibly NA patients. Most AH admissions had biochemically non-severe AH. Further research is needed to investigate these ethnic disparities.