Alcoholic Hepatitis Admissions of Young Adults Spike in Pandemic

Neil Osterweil

November 15, 2021

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In the first year of the COVID-19 pandemic, hospital admissions for alcoholic hepatitis (AH) among adults aged 40 years and younger doubled in Boston's largest hospital system compared with the average of the prior 4 prepandemic years, according to a new study.

Beginning March 2020, hospitals in the Mass General Brigham (MGB) system saw a numerical but not statistically significant increase in mean admissions per month of adults of all ages with AH over the control period of March 2016 to March 2020.

Among those aged 40 years and younger, however, AH admissions increased significantly, said Reid Grinspoon, AB, a fourth-year medical student at Harvard Medical School, during a presentation of the findings at The Liver Meeting 2021: American Association for the Study of Liver Diseases (AASLD), held online.

"What was striking about the study was that we saw a doubling of hospitalizations, a really important benchmark of severity of disease, among very young adults," said senior author Raymond T. Chung, MD, director of the Hepatology and Liver Center and vice chief of gastroenterology at Massachusetts General Hospital (MGH). Chung is the current president of the AASLD.

"More research is needed to quantify the effects of the pandemic on alcohol-associated liver disease, especially among young people," added Grinspoon, who is a member of the COVID-19 Research Group at the MGH Liver Center in Boston.

"Striking" Changes in Alcohol Use

Grinspoon and colleagues undertook their study to see whether the "striking" changes in patterns of alcohol use among adults aged 40 years and younger during the COVID-19 pandemic would have significant consequences in terms of liver disease.

They generated a list of patients from the MGB Research Patient Data Registry who were admitted with a diagnosis of AH from 2010–2021. Of those patients, 583 adults met the criteria, including 421 patients aged 41 years and older and 162 patients aged 40 years and younger.

Among all patients, there was a 35% increase in admissions in the first year of the pandemic compared with the control period, as well as an increase in mean admissions per month from 9.1 to 12.3, although this difference was not statistically significant.

For those patients aged 40 years and younger, AH admissions statistically significantly increased from a mean of 2.3 per month in the control period to 4.5 in the first year of the pandemic (P = .007).

Among the 30 patients in this group for whom a reason for increased drinking was identified, 12 cited COVID-related factors.

The investigators also saw a significant decrease in the mean age at admission, from 48.1 years before the pandemic to 45.8 years during the pandemic (P = .04), and an increase in mean Model for End-Stage Liver Disease–Sodium (MELD-Na) score from 24.8 before the pandemic to 24.6 during the pandemic (P = .04).

Grinspoon said that from early population-based studies of drinking patterns during the pandemic, they had expected to see an increase in AH among women. "Our data didn't bear that out," he said.

Transplant Evaluations Doubled

The investigators also compared the numbers of transplant evaluations and liver transplants in 2018 and 2019 with the numbers during the first year of the pandemic.

In 2018, hospitals in the MGB system implemented a new liver transplant protocol that broadened eligibility criteria to include patients with a first-time hospitalization for AH who have excellent social support and a low risk for recidivism.

The study showed that the rate of transplant evaluations for AH was more than double in the first year of the pandemic compared with the first 2 years since the protocol was initiated. There was also a numerical but not statistically significant increase in the proportion of patients who underwent liver transplant between the two periods, from 2.3% to 6.1%.

Chung told Medscape Medical News that the increase in the proportion of younger patients who require liver transplants "is an indicator of severe alcoholic hepatitis that was of a brand new nature, that is to say, it was not the result of a chronic problem."

Although the investigators could not definitively link pandemic-related drinking to the increase in AH cases and transplants, the timing of the association is unlikely to be a coincidence, Chung said.

Similar Findings Elsewhere

Vijay Shah, MD, a hepatologist at the Mayo Clinic, Rochester, Minnesota, who was not involved in the study, said that he has also seen a shift toward younger patients presenting with AH at his center.

"I think it's a national trend, probably international," he told Medscape Medical News.

The proportion of patients with end-stage AH who require transplant is also on the rise, he added.

"That's probably multifactorial. There are younger patients now with sick-liver disease, and then there's also an increasing trend to pursue liver transplantation in patients with advanced alcohol-associated liver disease, especially presenting with the clinical syndrome of alcohol-associated hepatitis," he said.

Shah commented that the rise in alcohol-associated liver disease during the pandemic may be due to a combination of increased drinking during a period of social isolation and to patients delaying hospital visits during the peak of the pandemic, resulting in more advanced-stage disease when they finally do seek medical help.

"There is an interplay of advanced liver diseases and COVID, such that patients with advanced liver disease have immunosuppression that can predispose them to COVID, and COVID will also predispose patients toward more advanced liver disease," he said.

No source of funding for the study has been disclosed. Grinspoon, Chung, and Shah have reported no relevant financial relationships.

The Liver Meeting 2021: American Association for the Study of Liver Diseases (AASLD): Abstract 40. Presented November 13, 2021.

Neil Osterweil, an award-winning medical journalist, is a long-standing and frequent contributor to Medscape.

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