Infection relief during pandemic may benefit AH patients receiving steroids

Key points:

• Patients with severe alcohol-related hepatitis who were treated with corticosteroids before COVID-19 had a higher mortality rate.
• Estimated survival probabilities are higher during the pandemic.

BOSTON — Patients with severe alcohol-related hepatitis who were treated with steroids had consistently lower mortality rates than during treatment. Prior to the COVID-19 pandemic, this population was likely to benefit from recommendations to mitigate infection.

“Incidences of alcohol use disorders and alcohol-related hepatitis have increased during the coronavirus pandemic,” Sammer Gao Rui,Medical PhD, said Healio, a clinical professor of medicine at Indiana University School of Medicine. “Infection mitigation measures are widely used, including limiting patient contact with visitors, universal mask wearing and emphasis on hand hygiene.

“Patients with severe AH are often treated with corticosteroids and are at increased risk for life-threatening infections. How infection control measures implemented during the pandemic affect infection and mortality in patients with severe AH is unknown.”

Gawrieh and colleagues combined data from five recent clinical trials, three of which were conducted before the pandemic, one during the pandemic, and one both before and during the pandemic. They compared 28, 90 and 180-day mortality in 575 patients with severe alcohol-related hepatitis who received corticosteroids before and during the pandemic (415 before COVID-19; 160 during COVID-19).

The researchers noted that patients recruited during the pandemic were slightly younger than those recruited before COVID-19 (43.7 years vs. 46.5 years), but the average MELD score was similar between the groups (24.8 vs. 25.7).

Results presented at the Liver Meeting showed that among pre-COVID patients, mortality rates at day 28 (11.6% vs. 2.5%), day 90 (22.4% vs. 10%) and day 180 (26.5% vs. 15%) Always higher. %).

“Of the five cohorts for which infection data were prospectively collected and reported, there was no overall difference in all infection rates in two cohorts,” Gowrie noted. “However, surprisingly, studies conducted during the pandemic reported that , these patients did not develop local or systemic fungal infections.”

After controlling for MELD and other patient characteristics, the researchers reported that the adjusted HRs for survival at 28, 90, and 180 days during the pandemic were 0.28 (95% CI, 0.1-0.79), 0.51 (95% CI, 0.3-0.87 ) and 0.57 (95% CI, 0.36-0.89). They also noted that estimated survival probabilities during this time were “significantly higher.”

“If confirmed, the findings will provide evidence to support infection mitigation measures as an important adjunct to other interventions used to treat and improve survival of patients with this life-threatening disease,” Gawrieh told Healio. “We are currently collecting detailed infection data from two of the five study cohorts to further validate the findings.”