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2021 ; 70
(3
): 531-536
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Comparison of mortality risk in patients with cirrhosis and COVID-19 compared
with patients with cirrhosis alone and COVID-19 alone: multicentre matched
cohort
#MMPMID32660964
Bajaj JS
; Garcia-Tsao G
; Biggins SW
; Kamath PS
; Wong F
; McGeorge S
; Shaw J
; Pearson M
; Chew M
; Fagan A
; de la Rosa Rodriguez R
; Worthington J
; Olofson A
; Weir V
; Trisolini C
; Dwyer S
; Reddy KR
Gut
2021[Mar]; 70
(3
): 531-536
PMID32660964
show ga
OBJECTIVE: 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. DESIGN: 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. RESULTS: 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.
CONCLUSIONS: 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.