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Z Gastroenterol 2021; 59(09): 954-960
DOI: 10.1055/a-1540-7726
Originalarbeit

Impact of the COVID-19 pandemic on patients with liver cirrhosis—the experience of a tertiary center in Germany

Einfluss der COVID-19 Pandemie auf die Notfallversorung von Patienten mit Leberzirrhose – Erfahrungen eines tertiären Zentrums
Christoph Höner zu Siederdissen
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
2   Emergency Department, Hannover Medical School, Hannover, Germany
,
Marie Schultalbers
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Maximilian Wübbolding
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Greta Sophie Lechte
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Hans Laser 
3   Center for Information Management (ZIMT), Hannover Medical School, Hannover, Germany
,
Markus Cornberg
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
4   Center for Individualised Infection Medicine (CIIM), Hannover, Germany,
,
Heiner Wedemeyer
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Benjamin Maasoumy
1   Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
4   Center for Individualised Infection Medicine (CIIM), Hannover, Germany,
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Abstract

Background The COVID-19 pandemic has caused a significant impact on the medical care of many diseases and has led to reduced presentations to the emergency department. Reduced presentations may be due to overwhelmed capacities of hospitals or collateral damage from fear of infection, lockdown regulations, or other reasons. The effect on patients with liver cirrhosis is not established.

Objective We aim to assess the impact on the care of patients with liver cirrhosis in a tertiary center in Northern Germany.

Methods All patients presenting to the emergency department with a diagnosis of cirrhosis between March 1 and May 31 from 2015–2020 were included. Reasons for presentation, duration of symptoms, the severity of liver disease, and 30-day mortality were assessed and compared between patients presenting during the COVID-19 pandemic and pre-COVID-19.

Results Overall, 235 patients were included. Despite an overall decline in presentations to the emergency department by 11.7%, the frequency of patients presenting with liver cirrhosis has remained stable (non-significant increase by 19.5%). No significant difference could be detected for the MELD score, the CLIF-organ failure subscores, and the 30-day mortality before and during the COVID-19 pandemic. Up to 75% of patients with liver cirrhosis had symptoms >24 h before presenting to the emergency department.

Conclusion Despite the overall trend of reduced emergency presentations during the COVID-19 pandemic, the frequency of presentations of patients with liver cirrhosis did not decline. Morbidity and mortality were not affected in a setting of disposable healthcare resources. The late presentation to the emergency department in many cirrhotic patients may open opportunities for interventions (i.e., with early telemedicine intervention).

Zusammenfassung

Hintergrund Die COVID-19 Pandemie hat einen deutlichen Einfluss auf die medizinische Versorgung und zu einer Abnahme von Vorstellungen in der Notaufnahme geführt. Die Gründe sind unklar, diskutiert werden eingeschränkte Versorgungskapazitäten der Krankhäuser, Angst vor einer Infektion oder Lockdown-Regelungen. Der Effekt auf Patienten mit einer Leberzirrhose ist unklar.

Ziel Den Einfluss auf die Notfallversorgung von Patienten mit Leberzirrhose in einem tertiären Zentrum in Deutschland zu untersuchen.

Methoden Alle Patienten mit der Diagnose Leberzirrhose, die sich zwischen dem 1. März und 31. Mai 2015–2020 in der Notaufnahme vorgestellt haben, wurden eingeschlossen. Die Gründe für die Vorstellung, die Dauer der Beschwerden, die Schwere der Lebererkrankung und die 30-Tage Mortalität wurde erfasst und zwischen den Patientkollektiven, die sich vor und während der COVID-19 Pandemie vorstellten, verglichen.

Ergebnisse Insgesamt wurden 235 Patienten eingeschlossen. Trotz einer Abnahme aller Notfallvorstellungen um 11.7%, blieb der Anteil von Patienten mit Leberzirrhose stabil (nicht signifikanter Anstieg um 19.5%). Kein signifikanter Unterschied konnte in Bezug auf den MELD-Score, den CLIF-organ failure Score und die 30-Tage Mortalität festgestellt werden. Bis zu 75% der Patienten mit Leberzirrhose hatten die Beschwerden, die zur Vorstellungen führten, >24 Stunden.

Schlussfolgerung Trotz des insgesamt vorliegenden Trends reduzierter Notfallvorstellungen, bleibt die Anzahl an Notfallvorstellungen von Patienten mit Leberzirrhose gleich. Die Morbidität und Mortalität werden nicht beeinflusst bei ausreichenden Versorgungskapazitäten. Die Zeitspanne zwischen Beschwerdebeginn und Vorstellung in der Notaufnahme von Patienten mit Leberzirrhose lässt Möglichkeiten zur Intervention, z.B. durch Telemedizin.

Schlüsselwörter

COVID - Zirrhose - Mortalität - Notfallversorgung

Keywords

COVID - Cirrhosis - Mortality - Emergency

Supporting information



Publication History

Received: 24 January 2021

Accepted after revision: 25 June 2021

Article published online:
10 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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