Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2023; 12(4): 221-232
Published online Sep 25, 2023. doi: 10.5501/wjv.v12.i4.221
Association between alcohol-associated cirrhosis and inpatient complications among COVID-19 patients: A propensity-matched analysis from the United States
Faisal Inayat, Hassam Ali, Pratik Patel, Rubaid Dhillon, Arslan Afzal, Attiq Ur Rehman, Muhammad Sohaib Afzal, Laraib Zulfiqar, Gul Nawaz, Muhammad Hassan Naeem Goraya, Subanandhini Subramanium, Saurabh Agrawal, Sanjaya K Satapathy
Faisal Inayat, Gul Nawaz, Muhammad Hassan Naeem Goraya, Department of Internal Medicine, Allama Iqbal Medical College, Lahore 54550, Punjab, Pakistan
Hassam Ali, Arslan Afzal, Subanandhini Subramanium, Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Pratik Patel, Department of Gastroenterology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
Rubaid Dhillon, Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Attiq Ur Rehman, Department of Hepatology, Mercy Medical Center, Baltimore, MD 21202, United States
Muhammad Sohaib Afzal, Department of Internal Medicine, Louisiana State University Health, Shreveport, LA 71103, United States
Laraib Zulfiqar, Department of Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur 63100, Punjab, Pakistan
Saurabh Agrawal, Department of Hepatology, Tampa General Medical Group and University of South Florida, Tampa, FL 33606, United States
Sanjaya K Satapathy, Department of Hepatology, North Shore University Hospital and Zucker School of Medicine at Hofstra University, Manhasset, NY 11030, United States
Author contributions: Inayat F, Ali H, Patel P, Dhillon R, and Afzal A concepted and designed the study, participated in the acquisition of data, interpretation of results, writing of the original draft, and critical revisions of the important intellectual content of the final manuscript; Rehman AU, Afzal MS, Zulfiqar L, Nawaz G, Goraya MHN, Subramanium S, and Agrawal S contributed to the analysis and interpretation of results and drafting of the manuscript; Satapathy SK reviewed, revised, and improved the manuscript by suggesting pertinent modifications; and all authors critically assessed, edited, and approved the final manuscript and are accountable for all aspects of the work.
Institutional review board statement: The data of patients was not acquired from any specific institution but rather open-access United States National Inpatient Sample (NIS) database. The NIS contains de-identified information, protecting the privacy of patients, physicians, and hospitals. Therefore, it was deemed exempt from the institutional review board.
Informed consent statement: Participants were not required to give informed consent for this retrospective cohort study since the analysis of baseline characteristics used anonymized clinical data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Faisal Inayat, MBBS, Research Scientist, Department of Internal Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore 54550, Punjab, Pakistan. faisalinayat@hotmail.com
Received: June 27, 2023
Peer-review started: June 27, 2023
First decision: July 19, 2023
Revised: August 2, 2023
Accepted: August 21, 2023
Article in press: August 21, 2023
Published online: September 25, 2023
Abstract
BACKGROUND

Alcohol-associated cirrhosis (AC) contributes to significant liver-related mortality in the United States. It is known to cause immune dysfunction and coagulation abnormalities. Patients with comorbid conditions like AC are at risk of worse clinical outcomes from coronavirus disease 2019 (COVID-19). The specific association between AC and COVID-19 mortality remains inconclusive, given the lack of robust clinical evidence from prior studies.

AIM

To study the predictors of mortality and the outcomes of AC in patients hospitalized with COVID-19 in the United States.

METHODS

We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database 2020. Patients were identified with primary COVID-19 hospitalizations based on an underlying diagnosis of AC. A matched comparison cohort of COVID-19 patients without AC was identified after 1:N propensity score matching based on baseline sociodemographic characteristics and Elixhauser comorbidities. Primary outcomes included median length of stay, median inpatient charges, and in-hospital mortality. Secondary outcomes included a prevalence of systemic complications.

RESULTS

A total of 1325 COVID-19 patients with AC were matched to 1135 patients without AC. There was no difference in median length of stay and hospital charges in COVID-19 patients with AC compared to non-AC (P > 0.05). There was an increased prevalence of septic shock (5.7% vs 4.1%), ventricular fibrillation/ventricular flutter (0.4% vs 0%), atrial fibrillation (13.2% vs 8.8%), atrial flutter (8.7% vs 4.4%), first-degree atrioventricular nodal block (0.8% vs 0%), upper extremity venous thromboembolism (1.5% vs 0%), and variceal bleeding (3.8% vs 0%) in the AC cohort compared to the non-AC cohort (P < 0.05). There was no difference in inpatient mortality in COVID-19 patients with non-AC compared to AC, with an odds ratio of 0.97 (95% confidence interval: 0.78-1.22, P = 0.85). Predictors of mortality included advanced age, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, fluid and electrolyte disorders, septic shock, and upper extremity venous thromboembolism.

CONCLUSION

AC does not increase mortality in patients hospitalized with COVID-19. There is an increased association between inpatient complications among COVID-19 patients with AC compared to non-AC.

Keywords: Alcoholic cirrhosis, COVID-19, Chronic liver disease, Mortality predictors, Inpatient complications

Core Tip: High-risk comorbid conditions significantly increase the mortality linked to coronavirus disease 2019 (COVID-19). In this large National Inpatient Sample-based retrospective cohort study, we aimed to evaluate the specific clinical impact of alcohol-associated cirrhosis (AC) on patients hospitalized with COVID-19. We analyzed the patient outcomes based on comorbidities, mechanical ventilation, intensive care unit admission, and mortality predictors. Our findings show that AC does not increase mortality in patients hospitalized with COVID-19. Pertinently, there is an increased association between inpatient complications and COVID-19 patients with AC compared to non-AC. Predictors of mortality included advanced age, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, fluid and electrolyte disorders, septic shock, and upper extremity venous thromboembolism.