S2578 Impact of COVID-19 on Outcomes in Patients With Acute Alcoholic Hepatitis: A Propensity-Matched Analysis Using a National Federated Database

Introduction: The surge in excessive alcohol drinking during the COVID-19 pandemic had led to rising incidence of Acute Alcoholic hepatitis (AAH) nationwide. AAH is a life-threatening condition with poor outcome as these patients usually are not transplant candidates. The impact of COVID-19 infection on AAH survival has been scarcely documented. We aim to evaluate the impact of concomitant COVID-19 infection on clinical outcomes in patients with AAH using a large national federated dataset. Methods: Using the TriNetX US Collaborative Network, we conducted a retrospective cohort study comparing patients with AAH and COVID-19 (Cohort A, n = 6,593) to patients with AAH without COVID-19 (Cohort B, n = 6,593) from January 2020 to May 2023. Propensity score matching (PSM) was performed on demographic and clinical covariates. Outcomes assessed included mortality, intubation, sepsis, and shock. Kaplan-Meier survival analysis and Cox proportional hazards modeling were used. Results: After PSM, 6,593 patients were included in each cohort. The mean follow-up duration was similar between groups, with a median of 749 days for the COVID-19 group and 673 days for the non-COVID group. Interestingly, the mortality rate was significantly lower in patients with AAH and concurrent COVID-19 compared to those without COVID-19, with a hazard ratio (HR) of 0.831 (P < 0.001) and a higher survival probability at the end of the study period (68.88% vs 61.24%). There was no statistically significant difference in the risk of intubation between the groups (HR: 1.079, P = 0.597), and Kaplan-Meier analysis showed overlapping survival curves for this outcome. Similarly, while patients in the COVID-19 group had a slightly higher incidence of sepsis, the difference did not reach statistical significance (HR: 1.092, P = 0.078). For the outcome of shock, hazard ratios were nearly identical between groups, indicating no meaningful difference (HR: 0.961, P = 1.000). Overall, the presence of COVID-19 in patients with AAH did not worsen critical care outcomes such as intubation, sepsis, or shock, and was paradoxically associated with lower mortality. Conclusion: Surprisingly, patients with AAH and concurrent COVID-19 had lower mortality compared to matched patients with AAH alone. Rates of intubation, sepsis, and shock were comparable. These findings highlight the evolving clinical management and outcomes of comorbid COVID-19 in liver disease and warrant further investigation.