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:
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.
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
Research background

Patients with chronic liver disease (CLD) may be at risk of adverse outcomes following coronavirus disease 2019 (COVID-19). Initial findings from Wuhan indicated potential liver injury in COVID-19 patients. With the growing role of obesity and alcohol, understanding the specific implications of alcohol-associated cirrhosis (AC) for patients with COVID-19 is of paramount clinical importance for prognostication and appropriate therapeutic strategy.

Research motivation

Cirrhosis is typically associated with immune system impairments, which might hinder the ability of patients to combat COVID-19. While several studies have indicated an increased risk of COVID-19 severity in cirrhotic patients, the specific impact of AC on inpatient outcomes remains incompletely defined.

Research objectives

This study primarily aims to assess the impact of AC on inpatient outcomes and mortality rates in patients hospitalized with COVID-19 compared to those without AC. Furthermore, we intend to identify predictors of mortality within the COVID-19 patient cohort with AC.

Research methods

A retrospective cohort study was conducted using the National Inpatient Sample database 2020, focusing on hospitalizations with a primary diagnosis of COVID-19. Two cohorts were established based on the presence or absence of AC. Propensity score matching was used to compare the cohorts and a range of statistical analyses were applied to the data.

Research results

Of the 738010 patients hospitalized with COVID-19 that fulfilled the selection criteria, 1325 with AC were compared to 1135 without AC. It was found that AC did not significantly increase mortality in COVID-19 patients. However, it was linked to a higher prevalence of inpatient complications, especially in certain demographics and those with higher Elixhauser Comorbidity Index scores.

Research conclusions

AC does not increase mortality rates in the context of COVID-19 hospitalizations. However, it is associated with a heightened prevalence of certain inpatient complications. Despite these systemic complications, there was no noticeable difference in intensive care unit requirements, length of stay, or hospital charges between AC and non-AC groups.

Research perspectives

This research provides valuable insights into the implications of AC for COVID-19 patients. It prompts clinicians to conduct future research and delve deeper into understanding the exact mechanisms leading to these complications in COVID-19 patients with AC. Exploring preventive measures or pharmacological treatment adjustments for this vulnerable population may improve patient outcomes.