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Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study.
- Source :
-
Journal of hepatology [J Hepatol] 2021 Mar; Vol. 74 (3), pp. 567-577. Date of Electronic Publication: 2020 Oct 06. - Publication Year :
- 2021
-
Abstract
- Background & Aims: Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined.<br />Methods: Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network.<br />Results: Mortality was 32% in patients with cirrhosis compared to 8% in those without (p <0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01-1.04), Child-Pugh A (OR 1.90; 1.03-3.52), B (OR 4.14; 2.4-7.65), or C (OR 9.32; 4.80-18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03-3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%-31.3%]) and C (+38.1% [27.1%-49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure.<br />Conclusions: In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic.<br />Lay Summary: This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease.<br />Competing Interests: Conflicts of interest The authors declare no conflicts of interest. Please refer to the accompanying ICMJE disclosure forms for further details.<br /> (Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Disease Progression
Female
Global Health statistics & numerical data
Hospitalization statistics & numerical data
Humans
Liver Function Tests methods
Male
Middle Aged
Mortality
Registries statistics & numerical data
Risk Assessment methods
Risk Factors
SARS-CoV-2 isolation & purification
United Kingdom epidemiology
Acute-On-Chronic Liver Failure diagnosis
Acute-On-Chronic Liver Failure epidemiology
COVID-19 mortality
COVID-19 therapy
Liver Cirrhosis diagnosis
Liver Cirrhosis epidemiology
Liver Cirrhosis etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1600-0641
- Volume :
- 74
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 33035628
- Full Text :
- https://doi.org/10.1016/j.jhep.2020.09.024