The effect of COVID-19 on patients with liver cirrhosis: A systematic review and meta-analysis of retrospective studies (Preprint)

Abstract

BACKGROUND Coronavirus disease 2019 (COVID-19) is long-lasting and has an adverse effect on liver function. However, the impact of COVID-19 on the outcome of patients with liver cirrhosis has not been consistently clear. OBJECTIVE We aimed to conduct a systematic review and meta-analysis to explore whether COVID-19 negatively impacts cirrhosis patients. METHODS We conducted a systematic search of the PubMed/Medline, Embase, and Cochrane Library databases to compare cirrhosis patients with and without COVID-19. Two authors independently performed data extraction and quality evaluation using the Newcastle‒Ottawa Scale. Data pooling was conducted using random-effects or fixed-effects models based on the heterogeneity of the included studies. RESULTS A total of 13 studies were included that involved 949 patients with cirrhosis and COVID-19 and 15,196 patients with cirrhosis only. Of the 13 studies, ten were studies among hospitalized patients, and three were studies among discharged patients. COVID-19 infection increased the mortality, ICU (Intensive Care Unit) admission rate, length of hospital stay and incidence of acute-on-chronic liver failure (ACLF), Child‒Pugh C and hepatic encephalopathy among hospitalized patients with liver cirrhosis. However, COVID-19 infection did not affect the mortality rate or the incidence of Child‒Pugh C among patients with cirrhosis after discharge. CONCLUSIONS In hospitalized patients with cirrhosis, infection with COVID-19 may be a potential risk factor for adverse clinical outcomes. However, COVID-19 infection seems to have no effect on patients with cirrhosis after discharge. It is recommended that clinicians pay more attention to the prevention and treatment of COVID-19 in patients with preexisting liver cirrhosis. CLINICALTRIAL PROSPERO CRD42023429256; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=429256