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Marjot, Thomas, Moon, Andrew M, Cook, Jonathan A, Abd-Elsalam, Sherief, Aloman, Costica, Armstrong, Matthew J, Pose, Elisa, Brenner, Erica J, Cargill, Tamsin, Catana, Maria-Andreea, Dhanasekaran, Renumathy, Eshraghian, Ahad, García-Juárez, Ignacio, Gill, Upkar S, Jones, Patricia D, Kennedy, James, Marshall, Aileen, Matthews, Charmaine, Mells, George, Mercer, Carolyn, Perumalswami, Ponni V, Avitabile, Emma, Qi, Xialong, Su, Feng, Ufere, Nneka N, Wong, Yu Jun, Zheng, Ming-Hua, Barnes, Eleanor, 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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