Predictors of Outcomes of COVID-19 in Patients With Chronic Liver Disease: US Multi-center Study

Abstract

Background Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19). Methods We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD. Results Of the 978 patients in our cohort, 867 patients (mean age 56.9±14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19. Conclusions The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19.

Liver injury in the era of COVID-19

“…A novel observational cohort study by Kim et al [ 77 ] of 867 patients with CLDs and coexisting COVID-19 revealed that ALD, decompensated cirrhosis and hepatocellular carcinoma may be predictors of higher overall mortality during the course of infection. This observation was recently confirmed in a subsequent large cohort study of 745 patients with CLDs and concomitant SARS-CoV-2 infection (including 386 patients with cirrhosis and 359 without cirrhosis).…”

SARS-CoV-2 infection in patients with autoimmune hepatitis

“…Since the onset of the pandemic, the scientific and clinical community have strived to understand the contributions of specific disease phenotypes to SARS-COV-2 susceptibility and subsequent adverse outcomes [ 2 ]. Recently, large international and multicentre cohorts have shown baseline liver disease severity and alcohol related liver disease (ALD) to be independently associated with COVID-19 mortality, with decompensated cirrhosis representing a particularly high-risk group [ [3] , [4] , [5] , [6] ]. In contrast, several studies have demonstrated no significant increased risk of critical COVID-19 in patients with previous liver transplantation despite high rates of immunosuppression [ [7] , [8] , [9] ].…”

Asthma in patients with coronavirus disease 2019

“…Subsequently, 44 articles were excluded because of a sample size less than 100, 47 articles were eliminated due to the potential duplicate patients, and two articles were removed because they reported unclear prevalence of asthma in COVID-19 patients (eTable 2). Ultimately, 116 articles (119 studies) 4 , 6 , 7 , 8 , 9 , 10 , 11 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ,…”