Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort

Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort

Comorbid conditions are associated with poor prognosis in COVID-19. Registry data show that patients with cirrhosis may be at high risk. However, outcome comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone and cirrhosis alone are lacking. The aim of this study was...

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Bibliographic Details
Published in:Gut Vol. 70; no. 3; p. 531
Main Authors: Bajaj, Jasmohan S, Garcia-Tsao, Guadalupe, Biggins, Scott W, Kamath, Patrick S, Wong, Florence, McGeorge, Sara, Shaw, Jawaid, Pearson, Meredith, Chew, Micheal, Fagan, Andrew, de la Rosa Rodriguez, Randolph, Worthington, Janelle, Olofson, Amy, Weir, Vanessa, Trisolini, Calvin, Dwyer, Sarah, Reddy, K Rajender
Format: Journal Article
Language:English
Published: England 01-03-2021
Subjects:
COVID-19 - complications
COVID-19 - mortality
Female
Humans
Inpatients
Liver Cirrhosis - complications
Liver Cirrhosis - mortality
Male
Middle Aged
Pneumonia, Viral - complications
Pneumonia, Viral - mortality
Pneumonia, Viral - virology
Risk
SARS-CoV-2
United States
United States
chronic liver disease
infectious disease
cirrhosis
liver cirrhosis
sepsis
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Summary:Comorbid conditions are associated with poor prognosis in COVID-19. Registry data show that patients with cirrhosis may be at high risk. However, outcome comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone and cirrhosis alone are lacking. The aim of this study was to perform these comparisons. A multicentre study of inpatients with cirrhosis+COVID-19 compared with age/gender-matched patients with COVID-19 alone and cirrhosis alone was performed. COVID-19 and cirrhosis characteristics, development of organ failures and acute-on-chronic liver failure (ACLF) and mortality (inpatient death+hospice) were compared. 37 patients with cirrhosis+COVID-19 were matched with 108 patients with COVID-19 and 127 patients with cirrhosis from seven sites. Race/ethnicity were similar. Patients with cirrhosis+COVID-19 had higher mortality compared with patients with COVID-19 (30% vs 13%, p=0.03) but not between patients with cirrhosis+COVID-19 and patients with cirrhosis (30% vs 20%, p=0.16). Patients with cirrhosis+COVID-19 versus patients with COVID-19 alone had equivalent respiratory symptoms, chest findings and rates of intensive care unit transfer and ventilation. However, patients with cirrhosis+COVID-19 had worse Charlson Comorbidity Index (CCI 6.5±3.1 vs 3.3±2.5, p<0.001), lower presenting GI symptoms and higher lactate. Patients with cirrhosis alone had higher cirrhosis-related complications, maximum model for end-stage liver disease (MELD) score and lower BiPAP/ventilation requirement compared with patients with cirrhosis+COVID-19, but CCI and ACLF rates were similar. In the entire group, CCI (OR 1.23, 95% CI 1.11 to 1.37, p<0.0001) was the only variable predictive of mortality on multivariable regression. In this multicentre North American contemporaneously enrolled study, age/gender-matched patients with cirrhosis+COVID-19 had similar mortality compared with patients with cirrhosis alone but higher than patients with COVID-19 alone. CCI was the only independent mortality predictor in the entire matched cohort.
ISSN:1468-3288
DOI:10.1136/gutjnl-2020-322118