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

Authors
  • Bajaj, Jasmohan S1, 2
  • Garcia-Tsao, Guadalupe3
  • Biggins, Scott W4
  • Kamath, Patrick S5
  • Wong, Florence6
  • McGeorge, Sara2
  • Shaw, Jawaid2
  • Pearson, Meredith4
  • Chew, Micheal3
  • Fagan, Andrew2
  • de la Rosa Rodriguez, Randolph3
  • Worthington, Janelle5
  • Olofson, Amy5
  • Weir, Vanessa7
  • Trisolini, Calvin7
  • Dwyer, Sarah7
  • Reddy, K Rajender7, 8
  • 1 Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA [email protected]
  • 2 Department of Medicine, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Health Care System, Richmond, Virginia, USA.
  • 3 Department of Medicine, Internal Medicine, Yale University, New Haven, Connecticut, USA.
  • 4 University of Washington, Seattle, Washington, USA.
  • 5 Department of Medicine, Gastroenterology and Hepatology, Mayo Medical School, Rochester, Minnesota, USA.
  • 6 Toronto General Hospital, Toronto, Ontario, Canada. , (Canada)
  • 7 Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • 8 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Type
Published Article
Journal
Gut
Publisher
BMJ
Publication Date
Mar 01, 2021
Volume
70
Issue
3
Pages
531–536
Identifiers
DOI: 10.1136/gutjnl-2020-322118
PMID: 32660964
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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