Coronavirus in Scotland: The effect of COVID-19 lockdown on admissions with chronic liver disease

ABSTRACT

Background: COVID-19 lockdown began in Scotland on 23rd March 2020. This was followed by a significant reduction in unselected medical admissions to Scottish hospitals with increased illness severity and in-patient mortality This study aimed to investigate the specific effect of lockdown on admissions with liver disease in Scotland Methods: Patients admitted to 7 major Scottish hospitals with chronic liver disease in April 2020 were identified and compared with admissions in April 2017, 2018 and 2019 (n=459) Data was collected on patient demographics and disease characteristics Socioeconomic deprivation was derived from the Scottish Index of Multiple Deprivation (SIMD) in quintiles for analysis (1=most deprived;5=least deprived) Statistical analysis was done using SPSS version 22 Results: The median age of the whole cohort was 58 years (IQR 49-66) They were predominantly male (n=267;58 2%) 204 (44 4%) were from the most deprived quintile of the population The median MELD was 16 (IQR 12-21) 354 (77 1%) had alcoholic liver disease (ALD) as either the primary or a contributory factor to their disease Median length of stay was 7 days (IQR 4-14) 46 patients died in hospital giving an inpatient mortality of 9 8% Table 1 outlines the comparisons between patients admitted in April 2020 (n=111) and the previous 3 years (n=348) No difference was seen in age (59 years vs 58;p=0 88) or gender (59 men (53 2%) vs 208 men (59 8%);p=0 22) Severity of liver disease on admission was similar (MELD 15 vs 16;p=0 68) Although serum sodium was reduced in the pre-COVID era group (135 (130-138), n=348) compared with the COVID-lockdown cohort (137 (132-140), n=111) (p=0.01) no significant differences were seen in other blood parameters Length of stay (7 days vs 8 days;p=0 093), inpatient mortality (8 3% vs 10 4%;p=0 51) and socioeconomic deprivation by SIMD (p=0 41) were not significantly different between the two cohorts. There was not a significant difference between the number of patients admitted in each year (poisson regression analysis p=0 37) Conclusion: The lockdown introduced to control the COVID pandemic in Scotland did not have a significant impact on the number, severity of liver disease at presentation or outcomes in patients admitted with chronic liver disease, in contrast with unselected medical admissions in the immediate post lockdown period(Table Presented).