Understanding and Responding to the COVID-19 Pandemic Effect on the Magnitude of Alcohol-Related Liver Disease in Alberta.

Approximately 1 in 4 Canadians is practicing high-risk alcohol drinking (more than 10 drinks a week for women and 15 drinks a week for men) based on the Canadian guidelines. There has been a striking increase of alcohol sales and consumption in relation to the pandemic. One in 3 adult people who practice high-risk alcohol consumption (also known as heavy alcohol drinking) has alcohol-related liver disease (ArLD) which accounts for nearly 50% of deaths related to end-stage liver disease. ArLD patients experience worse clinical outcomes compared to other patients with chronic liver disease. The severity of ArLD depends on alcohol consumption and stage of liver scarring, known as fibrosis. Currently, there are no clinical care pathways designed for early detection of individuals with ArLD and risk stratification before they are diagnosed with end-stage liver disease. With the recent increase in alcohol sales, hospitalizations, and mortality related to ArLD in Canada, there is an urgent need to establish a clinical care pathway to identify and risk stratify patients with ArLD. In our proposed project, we aim to evaluate the burden of ArLD in Alberta in relation to the pandemic. Our goal is to develop and evaluate the first clinical care pathway to identify and risk stratify patients with ArLD in primary care in the Calgary Health Zone using simple non-invasive serum markers. We will connect patients at risk of advanced liver scarring due to ArLD with multi-disciplinary teams to provide medical and social care. We will also evaluate the performance of our clinical pathway and compare two common modalities to risk stratify liver fibrosis among patients with ArLD (serum-based and ultrasound-based). This project is novel, timely, and essential to meet the urgent and unmet need of identifying and supporting the increasing number of ArLD patients in relation to the COVID-19 pandemic.