Cargando…
Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation
INTRODUCTION: The global pandemic has diverted resources away from management of chronic diseases, including cirrhosis. While there is increasing knowledge on COVID-19 infection in liver cirrhosis, little is described on the impact of the pandemic on decompensated cirrhosis admissions and outcomes,...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9853150/ https://www.ncbi.nlm.nih.gov/pubmed/36650007 http://dx.doi.org/10.1136/bmjgast-2022-001071 |
_version_ | 1784872829259350016 |
---|---|
author | Gananandan, Kohilan Phillips, Alexandra Chikhlia, Anmol Old, Hannah Sim, Sharmaine Jia Ying Thakur, Niharika Hussain, Ishrat Kazankov, Konstantin Mookerjee, Rajeshwar P |
author_facet | Gananandan, Kohilan Phillips, Alexandra Chikhlia, Anmol Old, Hannah Sim, Sharmaine Jia Ying Thakur, Niharika Hussain, Ishrat Kazankov, Konstantin Mookerjee, Rajeshwar P |
author_sort | Gananandan, Kohilan |
collection | PubMed |
description | INTRODUCTION: The global pandemic has diverted resources away from management of chronic diseases, including cirrhosis. While there is increasing knowledge on COVID-19 infection in liver cirrhosis, little is described on the impact of the pandemic on decompensated cirrhosis admissions and outcomes, which was the aim of this study. METHODS: A single-centre, retrospective study, evaluated decompensated cirrhosis admissions to a tertiary London hepatology and transplantation centre, from October 2018 to February 2021. Patients were included if they had an admission with cirrhosis decompensation defined as new-onset jaundice or ascites, infection, encephalopathy, portal hypertensive bleeding or renal dysfunction. RESULTS: The average number of admissions stayed constant between the pre-COVID-19 (October 2018–February 2020) and COVID-19 periods (March 2020–February 2021). Patients transferred in from secondary centres had consistently higher severity scores during the COVID-19 period (UK Model for End-Stage Liver Disease 58 vs 54; p=0.007, Model for End-Stage Liver Disease-Sodium 22 vs 18; p=0.006, EF-CLIF Acute Decompensation (AD) score 55.0 vs 51.0; p=0.055). Of those admitted to the intensive care without acute-on-chronic liver failure, there was a significant increase in AD scores during the COVID-19 period (58 vs 48, p=0.009). In addition, there was a trend towards increased hospital readmission rates during the COVID-19 period (29.5% vs 21.5%, p=0.067). When censored at 30 days, early mortality postdischarge was significantly higher during the COVID-19 period (p<0.001) with a median time to death of 35 days compared with 62 days pre-COVID-19. DISCUSSION: This study provides a unique perspective on the impact that the global pandemic had on decompensated cirrhosis admissions. The findings of increased early mortality and readmissions, and higher AD scores on ICU admission, highlight the need to maintain resourcing for high-level hepatology care and follow-up, in spite of other disease pressures. |
format | Online Article Text |
id | pubmed-9853150 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-98531502023-01-21 Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation Gananandan, Kohilan Phillips, Alexandra Chikhlia, Anmol Old, Hannah Sim, Sharmaine Jia Ying Thakur, Niharika Hussain, Ishrat Kazankov, Konstantin Mookerjee, Rajeshwar P BMJ Open Gastroenterol Hepatology INTRODUCTION: The global pandemic has diverted resources away from management of chronic diseases, including cirrhosis. While there is increasing knowledge on COVID-19 infection in liver cirrhosis, little is described on the impact of the pandemic on decompensated cirrhosis admissions and outcomes, which was the aim of this study. METHODS: A single-centre, retrospective study, evaluated decompensated cirrhosis admissions to a tertiary London hepatology and transplantation centre, from October 2018 to February 2021. Patients were included if they had an admission with cirrhosis decompensation defined as new-onset jaundice or ascites, infection, encephalopathy, portal hypertensive bleeding or renal dysfunction. RESULTS: The average number of admissions stayed constant between the pre-COVID-19 (October 2018–February 2020) and COVID-19 periods (March 2020–February 2021). Patients transferred in from secondary centres had consistently higher severity scores during the COVID-19 period (UK Model for End-Stage Liver Disease 58 vs 54; p=0.007, Model for End-Stage Liver Disease-Sodium 22 vs 18; p=0.006, EF-CLIF Acute Decompensation (AD) score 55.0 vs 51.0; p=0.055). Of those admitted to the intensive care without acute-on-chronic liver failure, there was a significant increase in AD scores during the COVID-19 period (58 vs 48, p=0.009). In addition, there was a trend towards increased hospital readmission rates during the COVID-19 period (29.5% vs 21.5%, p=0.067). When censored at 30 days, early mortality postdischarge was significantly higher during the COVID-19 period (p<0.001) with a median time to death of 35 days compared with 62 days pre-COVID-19. DISCUSSION: This study provides a unique perspective on the impact that the global pandemic had on decompensated cirrhosis admissions. The findings of increased early mortality and readmissions, and higher AD scores on ICU admission, highlight the need to maintain resourcing for high-level hepatology care and follow-up, in spite of other disease pressures. BMJ Publishing Group 2023-01-17 /pmc/articles/PMC9853150/ /pubmed/36650007 http://dx.doi.org/10.1136/bmjgast-2022-001071 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Hepatology Gananandan, Kohilan Phillips, Alexandra Chikhlia, Anmol Old, Hannah Sim, Sharmaine Jia Ying Thakur, Niharika Hussain, Ishrat Kazankov, Konstantin Mookerjee, Rajeshwar P Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
title | Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
title_full | Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
title_fullStr | Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
title_full_unstemmed | Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
title_short | Negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
title_sort | negative impact of the pandemic on hospital admissions, morbidity and early mortality for acute cirrhosis decompensation |
topic | Hepatology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9853150/ https://www.ncbi.nlm.nih.gov/pubmed/36650007 http://dx.doi.org/10.1136/bmjgast-2022-001071 |
work_keys_str_mv | AT gananandankohilan negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT phillipsalexandra negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT chikhliaanmol negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT oldhannah negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT simsharmainejiaying negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT thakurniharika negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT hussainishrat negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT kazankovkonstantin negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation AT mookerjeerajeshwarp negativeimpactofthepandemiconhospitaladmissionsmorbidityandearlymortalityforacutecirrhosisdecompensation |