S3533 Indirect Impacts of COVID on Alcohol-Induced Liver Disease

Abstract

INTRODUCTION: There is a paucity of COVID-19-negative patients who experienced alcohol-induced liver injury due to the disruption of daily activities and social isolation. CASE DESCRIPTION/METHODS: A 42-year-old male with history of alcohol induced liver cirrhosis (6 months prior MELD-Na 13, Child Pugh A, small esophageal varices and mild portal hypertensive gastropathy) presented to emergency room with 1 week of worsening abdominal pain and distension. For the last 1 month, he increased his alcohol intake to 12 beers a day (prior only 6 beers daily, last drink was 2 days ago); he states this increase was due to loss of employment and living alone. He denied any COVID-19 symptoms and tested negative. On admission, MELD-Na roughly tripled at 32 and Child Pugh now C. Labs were notable for severe hyponatremia (103 mEq/L), AST: ALT ratio ∼3:1 and acute kidney injury, concern for hepatorenal syndrome. He had tense ascites, no asterixis and A&Ox4. His hyponatremia resolved with appropriate therapy, paracentesis was negative for spontaneous bacterial peritonitis, kidney function improved on midodrine, octreotide and albumin. Yet, he developed multifactorial encephalopathy (alcohol withdrawal, ICU delirium and hepatic encephalopathy), not resolved with lactulose and rifaximin, which prolonged his hospitalization. His final days of admission were in MICU for presumed aspiration versus hospital acquired pneumonia, retest for COVID-19 were again negative. His family agreed to comfort care and the patient passed on hospital day 22. DISCUSSION: Our patient demonstrates the significant indirect effects of the COVID-19 pandemic on patients with alcohol induced liver disease. Recent publications predicted that relapses in alcohol abstinence, admissions, and new diagnoses of alcoholic liver disease would increase during quarantine.1-3 Future studies should investigate the increase in alcohol related relapses, admission, and mortality. Our patient is just one of many who, despite not contracting COVID-19, experienced negative health outcomes attributable to the pandemic.