Pandemic’s impact on liver disease highlighted at liver meeting

Mortality from alcohol-associated liver disease has soared during the COVID-19 pandemic, researchers have reported in a series of studies set to be presented at the American Association for the Study of Liver Diseases (AASLD).

Deaths from both alcohol-related liver disease and non-alcoholic fatty liver disease (NAFLD) showed “alarming” rising trends from 2010 to 2021, with surges during the pandemic, reported Yee Hui Yeo, MD, of Cedars-Sinai Medical Center in Los Angeles.

For NAFLD, death rates increased almost twice as much among people aged 25 to 44 (annual percentage increase of 28.4%) during the pandemic than what was seen among people aged 45 to 64 ( 7.4%) or older people (12%). Yeo reported at a press conference ahead of the presentation at the Liver Disease Meeting, which begins Friday in Washington, D.C.

The non-Hispanic American Indian and Alaska Native groups had the most pronounced increase in death rates from alcohol-related liver disease.

The data comes from the CDC National Vital Statistics System dataset, “which includes over 99% of the population of all deaths in the United States each year,” Yeo said.

From this data, the researchers were able to accurately identify patients who died of the ‘big four’ chronic liver diseases – alcoholic liver disease, NAFLD, hepatitis B and hepatitis C – and then used statistical analysis to examine trends in causes. of deceased.

Between 2010 and 2021, about 340,000 patients died from alcohol-related liver disease, followed by 200,000 from hepatitis C, 58,000 from NAFLD and 20,000 from hepatitis B, a-t -he explains.

“The trend for these four diseases varied widely,” Yeo said. While the cure for hepatitis C emerged from late 2013 to early 2014, the increase in deaths related to hepatitis C infection from 2010 to 2014 turned into “a significant decrease from 2014 to 2019”.

“However, during the pandemic, we have seen that this decrease has become a non-significant change, which means that our progress for the past 5 or 6 years has already stopped during the pandemic,” Yeo added.

Despite slightly lower death rates over the past 10 years, hepatitis B-related deaths have not changed significantly during the pandemic.

Alcoholic hepatitis during the pandemic

Another, albeit smaller, study presented at the press conference also showed an increase in cases of alcohol-related hepatitis during the pandemic.

After reviewing data from electronic medical records from 2019 to 2021, only 131 alcohol-related hepatitis admissions were observed in 2019, compared to 215 such admissions in 2021 – a 64% increase in the total number of cases, a reported Aalam Sohal, MD, of the University of California San Francisco-Fresno.

“This increase, which is in and out of three hospital systems in Fresno, Calif., may reflect a broader national issue,” Sohal said.

Alcohol-related hepatitis has been significantly linked to morbidity, mortality, and healthcare costs. Hospital admissions during the pandemic for this disorder have remained well above pre-pandemic levels.

What Sohal called “more worrying” trends is that women accounted for 24% of alcohol-related hepatitis in 2019 but 67% in 2021 – a 179% increase in the total number of cases – and that patients under 40 jumped from 30% of cases in 2019 to 71% in 2021 (a 136% increase).

Readmissions for alcohol-related hepatitis also increased 4.5 times between 2019 and 2021, Sohal reported.

Added weight management to NAFLD care

According to Ysabel Ilagan-Ying, MD, of Yale University School of Medicine in New Haven, Connecticut, a multidisciplinary care program for NAFLD has boosted referrals for bariatric surgery by 25 times the national average.

Of more than 1,000 patients referred to Yale’s fatty liver program, in which hepatologists work in tandem with nutritionists and other medical weight management specialists, 25.1% of those eligible for bariatric surgery went there. been referred. The national average is less than 1%, Ilagan-Ying noted.

“It takes a village to fight obesity,” Ilagan-Ying said. “We all recognize that obesity is a growing problem.”

Fat stored in the liver can progress to fatty liver disease, she noted. “With prolonged inflammation and scarring from fatty liver disease, patients can progress to cirrhosis and liver cancer, which is why fatty liver disease is becoming the number one reason people need transplants. of liver in America.”

Losing at least 10% of total body weight is the treatment for fatty liver disease, which can be accomplished by highly effective bariatric surgical procedures, such as sleeve gastrectomy.

After studying more than 1,000 patients referred to the program from October 2015 to May 2022, 965 had fatty liver disease. Of these, 58% suffered from mood or anxiety disorders and 46% suffered from diabetes. Based on insurance criteria, 62% of patients were eligible for bariatric surgery.

While more than half of patients lost weight over 12 months, at the end of follow-up “all patients who underwent bariatric surgery reached their final predicted BMI,” Ilagan-Ying said. “Those who had surgery lost 20% of their body weight.”

Post-surgical complications were minimal. Not surprisingly, decreased nutritional absorption was the most common complication.

Other research

In a fourth study presented at the briefing, black and Latino individuals were significantly underrepresented in clinical trials evaluating cirrhosis in the United States.

These groups accounted for just 7% of enrollments in phase III clinical trials for cirrhosis, according to Paige McLean Diaz, MD, of Massachusetts General Hospital in Boston.

Race and ethnicity were also under-reported, being included in only 9% of trials (12 of 133).

“It is clear that barriers to clinical trial enrollment of racial and ethnic minority patients need to be systematically addressed to improve representation,” said McLean Diaz.

Other research highlighted at the press conference as data to watch for at the meeting included a study of a low-carb, high-fat diet to reduce lipids in NAFLD patients with type 2 diabetes; data on NAFLD and cardiovascular disease risk in inflammatory bowel disease; and trends in lives lost to cirrhosis before and after the pandemic.

  • Zaina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.

Disclosures

Yeo, Sohal, Ilagan-Ying and McLean Diaz did not disclose any relevant industry relationships.

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