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

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  • dc.contributor.author Rivera-Esteban, Jesús
  • dc.contributor.author Manzano-Nuñez, Ramiro
  • dc.contributor.author Broquetas, Teresa
  • dc.contributor.author Serra-Matamala, Isabel
  • dc.contributor.author Bassegoda, Octavi
  • dc.contributor.author Soriano-Varela, Agnès
  • dc.contributor.author Espín, Gemma
  • dc.contributor.author Castillo, Joaquín
  • dc.contributor.author Bañares, Juan
  • dc.contributor.author Carrión Rodríguez, José Antonio
  • dc.contributor.author Ginès, Pere
  • dc.contributor.author Graupera, Isabel
  • dc.contributor.author Pericàs, Juan
  • dc.date.accessioned 2023-01-31T07:14:53Z
  • dc.date.available 2023-01-31T07:14:53Z
  • dc.date.issued 2022
  • dc.description.abstract Background & aims: The COVID-19 pandemic has had a major 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 people with NAFLD cirrhosis. Methods: We conducted a before-after study in four University hospitals in Catalonia, Spain. Study subperiods were divided into Pre-pandemic (March/2019-February/2020) vs. Pandemic (March/2020-February/2021). The primary outcome was the rate of first liver-related event (LRE). Overall clinical outcomes (LREs plus cardiovascular plus all-cause mortality) were also assessed. Results: A total of 354 patients were included, all of whom were compensated at the beginning of the study period; 83 individuals (23.5%) had a history of prior hepatic decompensation. Mean age was 67.3 years and 48.3% were female. Median BMI was 31.2 kg/m2 and type 2 diabetes was present in 72.8% of 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 with 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 type 2 diabetes (odds ratio [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 Fibrosis-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. Conclusion: Overall, people with NAFLD cirrhosis did not present poorer liver-related outcomes during the first year of the pandemic. Health system preparedness seems key to ensure that people with NAFLD cirrhosis receive appropriate care during health crises.Lay summary: 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 in many countries. We aimed to analyze whether people with cirrhosis due to non-alcoholic fatty liver disease, who are particularly vulnerable to such lifestyle modifications, were significantly impacted during the first year of the pandemic. We compared the clinical situation of 354 patients one year before the pandemic 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, namely COVID-19 itself. Moreover, the care provided to these patients did not worsen during the first year of the pandemic.
  • dc.description.sponsorship TB has received educational and research support from Gilead and Abbvie. JMP reports having received consulting fees from Boehringer Ingelheim and Novo Nordisk. He has received speaking fees from Gilead, and travel expenses from Gilead, Rubió, Pfizer, Astellas, MSD, CUBICIN, and Novo Nordisk. He has received educational and research support from Gilead, Pfizer, Astellas, Accelerate, Novartis, Abbvie, ViiV, and MSD, and funds from European Commission/EFPIA IMI2 853966-2, IMI2 777377, H2020 847989, and ISCIII PI19/01898. Other authors: nothing to disclose. None of the authors have any personal conflict with regards to the present manuscript.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Rivera-Esteban J, Manzano-Nuñez R, Broquetas T, Serra-Matamala I, Bassegoda O, Soriano-Varela A, Espín G, Castillo J, Bañares J, Carrión JA, Ginès P, Graupera I, Pericàs JM. Impact of the COVID-19 pandemic on the care and outcomes of people with NAFLD-related cirrhosis. JHEP Rep. 2022 Nov;4(11):100574. DOI: 10.1016/j.jhepr.2022.100574
  • dc.identifier.doi http://dx.doi.org/10.1016/j.jhepr.2022.100574
  • dc.identifier.issn 2589-5559
  • dc.identifier.uri http://hdl.handle.net/10230/55493
  • dc.language.iso eng
  • dc.publisher Elsevier
  • dc.relation.ispartof JHEP Rep. 2022 Nov;4(11):100574
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/847989
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/853966
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/777377
  • dc.rights © 2022 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword COVID-19
  • dc.subject.keyword HCC, hepatocellular carcinoma
  • dc.subject.keyword NAFLD, non-alcoholic fatty liver disease
  • dc.subject.keyword Nonalcoholic fatty liver disease
  • dc.subject.keyword OR, odds ratio
  • dc.subject.keyword T2D, type 2 diabetes
  • dc.subject.keyword VCTE, vibration-controlled transient elastography
  • dc.subject.keyword cACLD, compensated advanced chronic liver disease
  • dc.subject.keyword Cirrhosis
  • dc.subject.keyword Health systems
  • dc.subject.keyword Liver outcomes
  • dc.title Impact of the COVID-19 pandemic on the care and outcomes of people with NAFLD-related cirrhosis
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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