S1739 Impact of COVID-19 on Hospitalized Patients With and Without Liver Cirrhosis: Analysis of National Inpatient Sample 2020-2021

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Introduction: Coronavirus disease 2019 (COVID-19) has been identified as a significant risk factor for poor outcomes in patients with liver cirrhosis. What makes this difficult to interpret is that there is a spectrum of severity with regards to patients with cirrhosis in terms of sequelae from portal hypertension and other comorbidities. We aim to investigate the impact of COVID-19 on hospitalized patients diagnosed with cirrhosis compared to those without cirrhosis in the US using the National Inpatient Sample (NIS) database for the years 2020-2021. Methods: Using the NIS 2020-2021, we identified hospitalized patients aged >18 with a principal diagnosis of COVID-19 using International Classification of Diseases-10 codes. The exposure of interest was liver cirrhosis. Outcomes of interest in this study were the mean length of stay (days), mean cost of hospitalization ($USD), admission to intensive care unit (ICU), presence of acute kidney injury, and inpatient mortality. Means and proportions were compared using the student’s t-test and chi-squared test respectively. We generated unadjusted odd ratios (OR) through univariate analysis after which an adjusted OR (aOR) were calculated using multivariate regression models. Results: Of the 2,573,077 adult hospitalizations with a principal diagnosis of COVID-19, 1.46% (37,670) had been diagnosed with liver cirrhosis. Of these patients, 58.65% were female (P< 0.01), 54.42% were White, 16.27% were African American, and 21.76% were Hispanic (Table 1). Compared to patients without liver cirrhosis, liver cirrhosis was associated with significantly increased mortality (P< 0.01; aOR 1.25), increased risk of ICU admissions (P< 0.01; aOR 1.17), and significantly lower rates of AKI (P< 0.01, aOR 0.81). There was no significant association between liver cirrhosis and mean length of stay(LOS) or mean cost of hospitalization. Conclusion: Our study shows that in hospitalizations with a principal diagnosis of COVID-19, liver cirrhosis is associated with significantly higher mortality and higher rates of ICU admission, which is comparable to other studies. What is interesting, however, is that there did not appear to be a significant association with mean length of stay or cost of hospitalization. With liver cirrhosis being a major risk factor for poor outcomes in the hospital setting, these findings warrant further investigation to identify how there is no significant difference between mean cost of hospitalization and mean LOS despite higher level of acuity and complexity of care in these patients. Table 1. - Baseline characteristics and outcomes of patients Baseline Characteristics Liver Cirrhosis Without Liver Cirrhosis P Value Mean Age (Years) 62.73 63.12 Female 58.65% 52.58% < 0.01 Charlson Comorbidity Index < 0.01 0 0.62% 31.65% 1 15.20% 27.58% 2 16.90% 15.55% 3 61.72% 25.22% Race < 0.01 White 54.42% 59.49% African American 16.27% 16.59% Hispanic 21.76% 16.84% Others 7.55% 7.08% Outcomes Liver Cirrhosis Without Liver Cirrhosis aOR/Coefficient 95% Confidence Interval P Value Mortality 17.44% 11.17% 1.25 [1.17, 1.33] < 0.01 ICU Admission 15.70% 10.38% 1.17 [1.09, 1.25] < 0.01 AKI 30.77% 24.71% 0.81 [0.76, 0.86] < 0.01 Mean Length of Stay (Days) 9.01 7.77 0.26 [-0.01, 0.52] 0.058 Mean Hospitalization Charges ($$$) $105,459 $85,748 2116 [-2266, 6498] 0.344

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