S1163 Prevalence of COVID-19 in Patients With Cirrhosis Undergoing Outpatient Pre-Endoscopy Testing

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) is an international public health crisis affecting medical care for many chronic disease populations, including those with cirrhosis. Routine care transformed to safely allow elective endoscopic procedures by obtaining a pre-endoscopy viral PCR nasal swab to minimize endoscopy staff exposure. Little data exists on the prevalence of asymptomatic cirrhotic COVID-19 positive patients or a comparison to the general community prevalence. We used pre-procedure testing data to estimate an asymptomatic prevalence in patients with cirrhosis. Methods: This is a retrospective review of all patients with cirrhosis undergoing ambulatory endoscopy at two hospitals and two endoscopy centers at Atrium Health in Charlotte, NC from 4/1/2020 through 12/31/2020. Pre-procedure SARS-CoV-2 RT PCR nasal swab testing was a mandatory requirement during these months. The number of positive nasal swabs were recorded. Patient demographics, clinical and laboratory data, COVID-19 clinical course, 90 day follow up for hospitalizations, decompensation, and/or “long haul” COVID-19 complications were recorded. Publicly available data on all elective Atrium Health positive pre-procedure and statewide prevalence rates were also recorded for these dates. Results: A total of 398 cirrhotic patients were scheduled for ambulatory endoscopy procedures with confirmed pre-procedure PCR testing, with 3 positive results (1.0%). All three developed mild symptoms and were automatically enrolled in Atrium Health virtual hospital observation for a minimum of 10 days, per protocol. Table 1 indicates clinical course and outcomes. During the same time period, the average daily positive rate of Atrium Health pre-procedure testing was 2.5% (range 0-11%). Available state data indicates the positive rate ranged from 5.4%-15.4%. Conclusion: This is the only known study evaluating the prevalence of asymptomatic cirrhotic COVID-19 patients for elective endoscopy. The prevalence in our cirrhosis population was much lower than the general patient pre-procedure positive rate and reported statewide community prevalence. The three positive cirrhosis patients in this study had a benign COVID-19 course. This data suggests that patients with compensated cirrhosis with asymptomatic SARS-CoV-2 infection may have a mild clinical course. It also indicates a very low prevalence of SARS-CoV-2 in cirrhotic patients presenting for outpatient elective endoscopy suggesting routine screening in this population is unnecessary.Table 1.: PCR positive patients with cirrhosis COVID clinical course including 90 day follow up for hospitalizations, decompensating events or COVID related complications.