Impact of the COVID-19 pandemic on the care and outcomes of patients with NAFLD-related cirrhosis

Abstract

The COVID-19 pandemic has had a strong, negative impact on health systems and many chronic diseases globally. We aimed to evaluate the impact of the first year of the pandemic on the outcomes of NAFLD cirrhosis patients.Before-after study conducted in 4 University hospitals in Catalonia, Spain. Study subperiods were divided in Pre-pandemic (March/2019-February/2020) vs. Pandemic (March/2020-February/2021). Primary outcome was the rate of first liver-related events (LRE). Overall clinical outcomes (LRE plus cardiovascular plus all-cause mortality) were also assessed.354 patients were included, all of whom were compensated at the beginning of the study period but 83 subjects (23.5%) had presented a prior hepatic decompensation. Mean age was 67.3 years and 48.3% were female. Median BMI was 31.2kg/m2 and type-2 diabetes (T2D) was present in 72.8% patients. The rates of first LRE in the Pre-pandemic and Pandemic periods were 7.4% and 11.3% (p=0.12) respectively. Whilst the rate of overall events was significantly higher in the Pandemic period (9.9% vs. 17.8%; p=0.009), this was strongly associated to COVID-19-related deaths. The rate of worsened metabolic status was significantly higher in the Pandemic period (38.4% vs.46.1%; p=0.041), yet this was not associated with the risk of first LRE during the Pandemic period, whereas T2D (OR 3.77,95%CI 1.15-12.32; p=0.028), albumin<4 g/L (OR 4.43,95%CI 1.76-11.17; p=0.002) and FIB-4 score >2.67 (OR 15.74,95%CI 2.01-123.22; p=0.009) were identified as risk factors in the multivariable analysis.Overall, patients with NAFLD cirrhosis did not present poorer liver-related outcomes during the first year of the pandemic. Health systems preparedness seems key to ensure NAFLD cirrhotic patients receive appropriate care during health crises.Mobility restrictions and social stress induced by the COVID-19 pandemic have led to increased alcohol drinking and worsened metabolic control (e.g., weight gain, poor control of diabetes) in a large proportion of the population from many countries. We aimed at analyzing whether patients with cirrhosis due non-alcoholic fatty liver disease, whom are particularly vulnerable to such lifestyle modifications, were significantly impacted during the first year of the pandemic. With that purpose, we studied 354 patients and compared their clinical situation one year before the pandemic outbreak and one year after. We found that although metabolic control was indeed worse after the first year of the pandemic and patients presented worse clinical outcomes, the latter was mostly due to non-liver causes but rather to COVID-19. Moreover, the care provided to cirrhotic patients with NAFLD did not worsen during the first year of the pandemic.© 2022 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).