1. The Outcome after Hospital Discharge in Cirrhosis is Not Worsened with COVID-19 Infection: A Propensity Score-matched Analysis
- Author
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Vaishnav, Manas, Elhence, Anshuman, Biswas, Sagnik, Pathak, Piysuh, Anand, Abhinav, Sheikh, Sabreena, Singh, Vishwajeet, Maitra, Souvik, Goel, Amit, and Shalimar
- Subjects
Alk P, alkaline phosphatase ,NAFLD, non-alcoholic fatty liver disease ,COVID-19, coronavirus disease-2019 ,CTP, Child-Turcotte-Pugh ,pandemic ,AIH, autoimmune hepatitis ,coronavirus ,INR, international normalized ratio ,chronic liver disease ,GI, Gastrointestinal ,virus ,AST, aspartate aminotransferase ,TLC, Total leukocyte count ,mortality ,AD, acute decompensation ,MELD, model for end-stage liver disease ,HBV, hepatitis B virus ,ACE2, Angiotensin-converting enzyme 2 ,ALT, alanine aminotransferase ,HCV, hepatitis C virus ,Original Article ,IQR, interquartile range - Abstract
Background Patients with cirrhosis and coronavirus disease-2019 (COVID-19) have high in-hospital mortality. The information on outcome of cirrhosis patients in post-hospitalization period are limited. Aims We aimed to study the outcome of cirrhosis patients with COVID-19 after hospital discharge. Methods The records of the cirrhosis patients discharged after COVID-19 were reviewed. Their data were compared with a similar number of cirrhosis patients without COVID-19 after propensity score matching for age, sex, etiology of cirrhosis, and model for end-stage liver disease (MELD) score. Results Cirrhosis patients with (n=92) or without (n=92) COVID-19 were included in 1:1 ratio. The mortality among COVID-19 (22; 23.9%) and non-COVID-19 (19; 20.7%) were comparable (HR 1.224; 95% CI 0.663-2.263, P=0.520), over a similar duration of follow-up [186 (86-271) vs 183 (103-274)]. Among COVID-19 patients, 45; 48.9% developed a new acute decompensation-increased ascites (40; 43.5%), hepatic encephalopathy (20; 21.7%), or variceal bleeding (8; 8.7%) whereas 25 (27.2%) patients needed re-hospitalization. A proportion of participants continued to have either fatigue/weakness (24/80; 30.0%), sleep disturbances (11/80; 13.7%), or joint pains (16/80; 20.0%). The most common causes of death in patients of both groups were end-stage liver disease: 16 (72.7%) vs 9 (47.4%), followed by multiorgan dysfunction: 4 (18.2%) vs 6 (31.6%), GI bleeding: 2 (9.1%) vs. 4 (21.0%), P=0.484. A lower albumin level, higher international normalized ratio, bilirubin, Child-Turcotte-Pugh, and MELD scores at discharge predicted mortality in the COVID-19 group. Conclusion Short-term outcomes of patients with cirrhosis who survive the initial insult of COVID-19 are not different from patients without COVID-19, and survival is determined by the severity of liver disease at discharge.
- Published
- 2021