For alcoholic or cirrhosis patients hospitalized because of Covid-19, the risk of dying was greater than for others in 2020, but this could come from poorer access to care, according to a French study .
The results “suggest that a limitation of active therapies could have contributed to the excess mortality of patients previously suffering from serious liver disease or disorders linked to alcohol consumption”, according to this work presented this week at the international congress of the liver.
A measure of access to care by patient category
“This is, to my knowledge, the first study to report a form of patient selection in France, measuring access to care by patient category”, comments its first author, Vincent Mallet, professor of hepatology and addictology at the Cochin Hospital in Paris.
For example, being a smoker or ex-smoker is not associated with poorer access to intubation and artificial ventilation, while it is the case for patients with a substance use disorder. alcohol. The study shows that suffering from alcohol consumption disorders or chronic liver disease (severe cirrhosis, cancer, etc.) reduced by a quarter the chances of being intubated in the event of Covid-19 severe, according to Professor Mallet.
A problem of stigma
Previous studies had already identified liver patients as being at risk for serious Covid. But the specificity of this is to make the link between their excess mortality and poorer access to care, previously observed in other countries, notably in the United States. The study, which aims only to make findings, does not put forward any hypothesis to explain these differences. But the Vincent Mallet notes that alcohol problems often go hand in hand with precariousness.
“This is an important study”, which is based on “solid data”, believes for his part Thomas Berg, deputy secretary of European Association for the Study of the Liver (EASL), organizer of this virtual congress. According to him, these results reflect a phenomenon that existed before Covid-19: liver patients often tend to be treated differently from others. “There is still a certain level of stigma around liver disease” because “there is always the perception that it is self-inflicted, linked to drugs or alcohol,” he said.
A higher mortality rate
The study focuses on patients hospitalized for Covid-19 in France during the first two waves of the epidemic. The analysis focused on the 259,110 adult patients with Covid-19 admitted to hospital in 2020 according to the national hospital database (PMSI) including diagnoses, deaths, and interventions such as intubation and ventilation. mechanical.
Almost 16,000 were diagnosed with chronic liver disease and 10,000 with alcohol problems prior to hospitalization. If we take all the patients, the hospital mortality rate was 15%. But it rose to 20% (or one in five) for patients with chronic liver disease.
Patients with less severe liver disease did not have a risk of excess mortality but had a higher ventilation rate. In total, more than 38,200 Covid patients died in hospital out of the 65,000 deaths from the epidemic recorded in 2020 by the health authorities.