P083 Impact of COVID infection on outcome of patients with acute on chronic liver failure

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Acute on chronic liver failure (ACLF) is a syndrome occurring in patients with chronic liver disease with or without cirrhosis characterised by acute hepatic decompensation and one or more extra hepatic organ failure with an increased mortality. Numerous factors have been studied which influence the outcome of these patients. Aim To assess the impact of COVID infection on management and treatment escalation of patients who presented with acute hepatic decompensation with known or unknown underlying chronic liver disease after risk stratification. Methodology Retrospective analysis of all patients admitted over two periods – Pre Covid (August 2019- March 2020- Group A) and Covid (April 2020 – December 2020- Group B) with acute decompensated liver disease at our hospital. Data was analyzed from patient notes and electronic records on the following variables: age, gender, etiology of liver disease, prognostication scores – Child Pugh, MELD, ACLF grade and WHO performance status. CLIF -C score was calculated for patients referred to intensive care unit. Patient outcome measures – mortality and duration of hospital stay was also recorded. Data was collected in 35/72 patients who were admitted in Group A and 31/95 patients in Group B due to non-availability of all patient notes. Results 6/35 patients (17%) died in Group A compared to 13/31(41.9%) patients in Group B. 8/31 had COVID pneumonitis, 7 died and 1 survived. Alcohol was the commonest cause of underlying liver disease in both groups (Group A 32/35, Group B 27/31). Decompensation episodes in Group A versus Group B are as follows: gastrointestinal bleed 17/35 (48%), 16/31(51%); Hepatic encephalopathy 9/35(25%), 6/31(19%); Spontaneous Bacterial peritonitis 9/35(25%), 9/31(29%) respectively. Table 1 shows median MELD, Childs Pugh, ACLF grade was almost similar in both groups along with further analysis into patients who recovered or died depending on ward based care versus ITU. Conclusion COVID pneumonitis influenced the outcome of patients admitted with hepatic decompensation resulting in increased mortality. Alcohol was the commonest cause of underlying liver disease in both Pre-COVID and COVID period. Age, nature of hepatic decompensation (Gastro-intestinal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis) CLIF-C score for patients referred to ITU and average hospital stay was not much different in both the groups. The median MELD and ACLF grade were higher in patients who died compared to those who recovered.

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