Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study.

Marjot, Thomas and Moon, Andrew M and Cook, Jonathan A and Abd-Elsalam, Sherief and Aloman, Costica and Armstrong, Matthew J and Pose, Elisa and Brenner, Erica J and Cargill, Tamsin and Catana, Maria-Andreea and Dhanasekaran, Renumathy and Eshraghian, Ahad and García-Juárez, Ignacio and Gill, Upkar S and Jones, Patricia D and Kennedy, James and Marshall, Aileen and Matthews, Charmaine and Mells, George and Mercer, Carolyn and Perumalswami, Ponni V and Avitabile, Emma and Qi, Xialong and Su, Feng and Ufere, Nneka N and Wong, Yu Jun and Zheng, Ming-Hua and Barnes, Eleanor and Barritt, Alfred S and Webb, Gwilym J (2020) Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study. Journal of hepatology. ISSN 1600-0641. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

BACKGROUND

Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation leading to concerns that these patients may be at risk of adverse outcomes following SARS-CoV-2 infection. However, the impact of COVID-19 among patients with pre-existing liver disease remains ill-defined.

METHODS

Data for CLD patients with SARS-CoV-2 were collected by two international registries. Comparisons were made with non-CLD patients with SARS-CoV-2 from a UK hospital network.

RESULTS

Between 25th March and 8th July 2020, 745 CLD patients were reported from 29 countries including 386 with cirrhosis and 359 without. Mortality was 32% in patients with cirrhosis compared with 8% in those without (p<0.001). Mortality in cirrhosis patients increased according to Child-Turcotte-Pugh class (CTP-A (19%), CTP-B (35%), CTP-C (51%)) and the main cause of death was respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (OR 1.02; 1.01-1.04), CTP-A (OR 1.90; 1.03-3.52), CTP-B (OR 4.14; 2.4-7.65), CTP-C cirrhosis (OR 9.32; 4.80-18.08) and alcohol related liver disease (ALD) (OR 1.79; 1.03-3.13). When comparing CLD versus non-CLD (n=620) in propensity-score-matched analysis there were significant increases in mortality with CTP-B +20.0% (8.8%-31.3%) and CTP-C cirrhosis +38.1% (27.1%-49.2%). Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of which 21% had no respiratory symptoms. 50% of those with hepatic decompensation had acute-on-chronic liver failure.

CONCLUSIONS

This is the largest reported cohort of CLD and cirrhosis patients with SARS-CoV-2 infection to date. We demonstrate that baseline liver disease stage and ALD are independent risk factor 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.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WF Respiratory system. Respiratory medicine
WI Digestive system. Gastroenterology
Divisions: Planned IP Care > Gastroentrology
Related URLs:
Depositing User: Beth Connors
Date Deposited: 26 Oct 2020 10:58
Last Modified: 28 Oct 2020 14:55
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3565

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