Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Issue 3 (13th July 2020)

• Record Type: Journal Article
• 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
• Is Part Of: Gut. Volume 70:Issue 3(2021)
• Page Start: 531
• Page End: 536
• Publication Date: 2020-07-13
• Subjects: cirrhosis -- liver cirrhosis -- chronic liver disease -- sepsis -- infectious disease; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2020-322118
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: 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. Design: 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. Results: 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. Conclusions: 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.