(599) Impact of COVID-19 on Short-Term Mortality in Critically Ill Patients With Cirrhosis

Introduction: Short-term mortality has been decreasing over the past decade among critically ill patients with cirrhosis. The COVID-19 pandemic has strained the healthcare system and was associated with increased mortality among non-COVID-19 critically ill patients in the general population, but its impact on those with cirrhosis is unknown. We aimed to examine the population-level prognostic impact of the pandemic on mortality of ICU admissions with cirrhosis.

Methods: We used a statewide dataset to identify ICU admissions aged ≥18 years with cirrhosis in Texas during 2016-2022. Cirrhosis was identified using validated ICD-10 code taxonomy and COVID-19 by ICD-10 code U071. Interrupted time series analysis (ITSA) with segmented hierarchical logistic models was used to estimate the prepandemic (1/1/2016-3/31/2020) trend, level (intercept) change, pandemic (4/1/2020-12/31/2022) trend, and change in trends in short-term mortality (defined as in-hospital death or discharge to hospice) among ICU admissions with cirrhosis. Models were expressed as average marginal effects (AME), indicating change in absolute probability of death. Sensitivity analyses were performed on those without COVID-19, those with sepsis, and the mechanically ventilated.

Results: There were 110,614 ICU admissions with cirrhosis during the study period (35.1% aged ≥65 years, 45.2% female, 2.4% with COVID-19, 16.7% with sepsis, and 14.2% mechanically ventilated). Short-term mortality during the prepandemic and pandemic periods was 19.8% and 22.5%, respectively. On ITSA, short-term mortality decreased during the prepandemic period (AME -0.18%/quarter [95% CI -0.20 to -0.13]), with level change (AME 1.82% [95% CI 1.16 to 2.48]), and rising mortality during the pandemic period (AME 0.11%/quarter [95% CI 0.04 to 0.19]), with significant trend change (p < 0.0001). Findings on sensitivity analyses were consistent with the primary model.

Conclusions: The COVID-19 pandemic reversed the prepandemic decreasing short-term mortality of critically ill patients with cirrhosis and was associated with acute rise and subsequent mortality uptrend. The observed trends were not driven by ICU admissions with COVID-19.