Introduction: COVID-19, in addition to its direct detrimental respiratory infection, is associated with multiple systemic complications involving different organs, including the liver. COVID-19 has been associated with liver injury through multiple mechanisms, including direct viral effects on liver cells, immune-mediated injury, cytokine-driven inflammation, ischemic hepatitis, microvascular thrombosis, and sepsis-related multiorgan dysfunction. Acute liver failure (ALF) is the acute form of liver damage, which has a high mortality, and recovery is dependent on various factors. We studied the effect of COVID-19 on clinical outcomes such as mortality, length of stay, and need for non-invasive and invasive ventilation in patients with acute liver failure. Methods: We performed a retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database from 2020 to 2022. Adult patients admitted to the hospital with acute liver failure were divided into 2 groups based on their COVID-19 infection status. We analyzed differences in mortality, length of stay, need for non-invasive and invasive ventilation, acute kidney injury, need for renal replacement therapy, and total charges to evaluate the effects on outcomes, and the results were then adjusted for demographic and hospital factors. Results: Of 633,155 patients with acute liver failure, 66,785 had concurrent COVID-19 infection, while 566,370 did not. Patients with concurrent COVID-19 infection had significantly higher in-hospital mortality (63.9% vs. 36.0%) and greater utilization of noninvasive ventilation (14.9% vs. 6.4%), invasive mechanical ventilation (68.9% vs. 41.7%), higher incidence of acute kidney injury (81.4% vs. 70.3%) and higher need for renal replacement therapy (26.8% vs. 16.9%). They also experienced longer hospital stays (17.1 vs. 10.7 days) and higher total charges ($345,072 vs. $221,268). The findings were statistically significant after adjusting for demographics and clinical factors. Conclusions: Patients hospitalized with acute liver failure and concurrent COVID-19 infection experienced worse clinical outcomes, including higher in-hospital mortality, greater need for ventilatory support and renal replacement therapy, and higher hospital resource utilization. Notably, COVID-19 was independently associated with worse outcomes even among patients with fewer baseline comorbidities. These findings underscore the importance of early recognition of COVID-19 in patients presenting with acute liver failure, as well as prompt, multidisciplinary management to optimize clinical outcomes.

Background: COVID-19, in addition to its direct detrimental respiratory infection, is associated with multiple systemic complications involving different organs, including the liver. COVID-19 has been associated with liver injury through multiple mechanisms including direct viral effects on liver cells, immune mediated injury, cytokine-driven inflammation, ischemic hepatitis, microvascular thrombosis, and sepsis-related multiorgan dysfunction. Acute liver failure (ALF) is the acute form of liver damage, which has a high mortality, and recovery is dependent on various factors. We studied the effect of COVID-19 on clinical outcomes such as mortality, length of stay, and need for non-invasive and invasive ventilation in patients with acute liver failure. Methods: We performed a retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database from 2020 to 2022. Adult patients admitted to the hospital with acute liver failure were divided into 2 groups based on their COVID-19 infection status. We analyzed the difference in the mortality, length of stay and need for non-invasive or invasive ventilation using odds ratio, to evaluate effects on outcomes, and results were then adjusted to demographic and hospital factors. Results: Patients with acute liver failure with COVID-19 had significantly increased in-hospital mortality (63.7 vs 35.3%), increased use of noninvasive ventilation (15.0% vs 6.5%) and invasive mechanical ventilation (68.5% vs 40.9%), along with a longer hospital stay (17.1 vs 10.7 days). The findings were concurrent with statistical significance after adjusting for demographics and clinical factors. Conclusions: Patients with COVID-19 infection admitted to the hospital with acute liver failure have poor clinical out-comes, with higher in-hospital mortality, higher need for ventilatory support, and longer length of stay. COVID-19 independently is associated with worse outcomes, which was noted even in individuals with less baseline comorbidities. Early recognition of COVID-19 infection and acute hepatic failure and prompt management by the multidisciplinary team is essential for better clinical outcomes.

Background: Diabetes mellitus (DM) is highly prevalent in the United States and increases the risk of severe illness in patients with COVID-19. We compared outcomes among adult COVID-19 hospitalizations with and without DM. Methods: We compared the National Inpatient Sample (2020–2022), using multivariate regression to adjust for potential confounders. Results: Among 5,934,565 hospitalizations for COVID-19, 2,155,978 (36.3%) had concomitant DM. The DM group had higher unadjusted in-hospital mortality (13.5% vs. 10.1%) and was associated with higher mortality after adjustment (aOR 1.17; 95% CI, 1.15–1.19; p < 0.001). DM was also independently associated with higher odds of acute respiratory failure (46.1% vs. 42.3%; aOR 1.12; 95% CI, 1.11–1.13; p < 0.001), greater use of invasive mechanical ventilation (aOR 1.35; 95% CI, 1.33–1.37; p < 0.001) and non-invasive ventilation (NIV; aOR 1.42; 95% CI, 1.40–1.45; p < 0.001). COVID-19 hospitalizations with DM also had higher rates of acute respiratory distress syndrome, acute kidney injury, renal replacement therapy, sepsis, septic shock, and vasopressor use, along with longer length of hospital stay and higher total hospitalization charges. In-hospital mortality among COVID-19 hospitalizations with DM was lower in 2022 than in 2020 and 2021. Conclusions: DM was associated with higher in-hospital mortality and greater respiratory, renal, and hemodynamic complications and hospital resource utilization.

Diabetes mellitus is highly prevalent in the United States and increases the risk of severe illness in patients with COVID-19. We compared outcomes in hospitalized COVID-19 patients with and without diabetes using the National Inpatient Sample (2020-2022), adjusting for confounders via multivariable logistic regression. Among 5,934,565 hospitalizations for COVID-19, 2,155,978 (36.3%) had concomitant diabetes. The diabetes group had higher unadjusted in-hospital mortality (13.5% vs. 10.1%), but was not independently associated with mortality after adjustment (aOR 0.98; 95% CI 0.97-1.00). However, diabetes was independently associated with higher incidence of acute respiratory failure (46.1% vs 42.3%, aOR 1.29; 95% CI: 1.27-1.30), greater need for invasive mechanical ventilation (aOR 1.22; 95% CI 1.20-1.24) and non-invasive ventilation (aOR 1.27; 95% CI 1.25-1.29). These patients also had higher rates of ARDS, acute kidney injury, renal replacement therapy, sepsis, septic shock, and vasopressor use, along with longer length of hospital stay and higher total charges of hospitalization. Mortality among COVID-19 patients with diabetes declined through 2020-2022 (15.8% to 8.4%). Diabetes was not independently associated with in-hospital mortality but was associated with greater respiratory, renal, hemodynamic complications and hospital resource utilization. Early recognition and management of diabetes is warranted in patients with COVID-19.

Background: COVID-19 infection has been a major cause of hospitalization and mortality in the United States. Patients with liver cirrhosis may be especially vulnerable to severe outcomes of COVID-19 infection because of immune dysfunction, systemic inflammation, portal hypertension, and reduced physiologic reserve. These factors can increase the risk of severe infection, multiorgan complications, and poor inpatient outcomes. Using the 2020-2022 United States National Inpatient Sample, this study evaluates the effect of cirrhosis among adults hospitalized with COVID-19. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) database. Adult hospitalizations with COVID-19 from 2020 to 2022 were included and stratified according to the presence or absence of cirrhosis. Using multivariable logistic regression analyses, we evaluated in-hospital mortality as the primary outcome. Secondary outcomes included need for mechanical ventilation, septic shock, ARDS, ECMO utilization, acute kidney injury, renal replacement therapy, length of stay, and hospital charges. Results: A total of 5,934,565 hospitalized COVID-19 patients were included, of which 115,170 had concomitant cirrhosis. COVID-19 patients with cirrhosis had a higher in-hospital mortality than those without cirrhosis (16.8% vs. 11.3%; aOR 1.28; 95% CI 1.22-1.32). Patients with liver cirrhosis were also associated with higher odds of invasive mechanical ventilation, vasopressor use and septic shock. Conclusions: Cirrhosis was independently associated with increased in-hospital mortality and complications including need for invasive mechanical ventilation and septic shock in adults hospitalized with COVID-19. Although mortality associated with these patients have declined over time, they represent a high risk group that requires close monitoring.

Asthma exacerbation, frequently triggered by viral infections, is a leading cause of hospitalization, respiratory failure, and death. COVID-19 and asthma share a bidirectional relationship, with each potentially worsening the other. We compared outcomes in hospitalized asthma exacerbation patients with and without COVID-19 using the National Inpatient Sample (2020–2022), adjusting for confounders via multivariable logistic regression. Among 603,219 hospitalizations for asthma exacerbation, 69,600 (11.5%) had concomitant COVID-19. The COVID-19 group had significantly higher in-hospital mortality (6.7% vs. 1.4%; aOR 6.09; 95% CI 5.54-6.69) and greater need for invasive mechanical ventilation (10.1% vs. 4.9%; aOR 2.30; 95% CI 2.15-2.45), despite lower non-invasive ventilation use. Mean length of stay (7.7 vs. 4.6 days) and total hospital charges ($97,133 vs. $58,547) were also higher. These patients were more critically ill, with higher rates of respiratory failure, ARDS, acute kidney injury, and pulmonary embolism, and greater use of ECMO, renal replacement therapy, tracheostomy, and vasopressors. COVID-19 was independently associated with worse clinical outcomes among hospitalized asthma exacerbation patients. Early recognition of COVID-19 in asthma exacerbation is warranted to guide risk stratification and timely management.