COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

Abstract

Background: Scientific evidence is lacking regarding the risk of patients with chronic liver disease (CLD) for COVID-19, and how these risks are affected by age, gender and race. Methods: We performed a case-control study of electronic health records of 62.2 million patients (age >18 years) in the US up to October 1st, 2020, including 1,034,270 patients with CLD, 16,530 with COVID-19, and 820 with both COVID-19 and CLD. We assessed the risk, disparities, and outcomes of COVID-19 in patients with six major CLDs. Findings: Patients with a recent medical encounter for CLD were at significantly increased risk for COVID-19 compared with patients without CLD, with the strongest effect in patients with chronic non-alcoholic liver disease [adjusted odd ratio (AOR)=13.11, 95% CI: 12.49À13.76, p < 0.001] and non-alcoholic cirrhosis (AOR=11.53, 95% CI: 10.69À12.43, p < 0.001), followed by chronic hepatitis C (AOR=8.93, 95% CI:8.25À9.66, p < 0.001), alcoholic liver damage (AOR=7.05, 95% CI:6.30À7.88, p < 0.001), alcoholic liver cirrhosis (AOR=7.00, 95% CI:6.15À7.97, p < 0.001) and chronic hepatitis B (AOR=4.37, 95% CI:3.35À5.69, p < 0.001). African Americans with CLD were twice more likely to develop COVID-19 than Caucasians. Patients with COVID-19 and a recent encounter for CLD had a death rate of 10.3% (vs. 5.5% among COVID-19 patients without CLD, p < 0.001) and a hospitalization rate of 41.0% (vs. 23.9% among COVID-19 patients without CLD, p < 0.001). Interpretation: Patients with CLD, especially African Americans, were at increased risk for COVID-19, highlighting the need to protect these patients from exposure to virus infection.

COVID-19 and Social Determinants of Health in Gastroenterology and Hepatology

“…The findings are consistent with studies that demonstrate an association between CLD and poor COVID-19 outcomes. 7 , 8 , 9 However, the results are in contrast to a recent multi-institutional study that found an association between Latino ethnicity and severe COVID-19 disease among patients with decompensated cirrhosis, but no association between Latino ethnicity and COVID-19–related mortality. 7 …”

Coronavirus Disease-2019 (COVID-19) and the Liver

“…There is very limited data on hepatitis C virus (HCV) and COVID-19. Wang et al , 52 in their case-control study of over 1 million patients with cirrhosis, included 16,530 with COVID-19 and 820 with COVID-19 and chronic liver disease (CLD) and reported higher odds for patients with HCV in acquiring COVID-19 than for those without [adjusted odds ratio of 12.9]. Thus, although these findings would support the notion that patients with HCV-related CLD are at a greater risk for acquiring COVID-19 infections, there is a dearth of data to validate this finding or identify the impact of COVID-19 on disease course, management and outcome.…”

Development of An Individualized Risk Prediction Model for COVID-19 Using Electronic Health Record Data

“…Accordingly, several predictive models that seek to optimize hospital resource management and clinical decisions have been developed (Jehi et al, 2020a;Jehi et al, 2020b;Gong et al, 2020;Liang et al, 2020;Wynants et al, 2020;Zhao et al, 2020). To a large degree, these informatic tools leverage the vast and rich health information available from Electronic Health Record (EHR) data (Jehi et al, 2020b;Oetjens et al, 2020;Osborne et al, 2020;Vaid et al, 2020;Wang et al, 2021a;Wang et al, 2021b;Estiri et al, 2021;Halalau et al, 2021;Schwab et al, 2021). EHR systems contain longitudinal data about patients' demographics, health history, current and past medications, hospital admissions, procedures, current and past symptoms and conditions.…”