TY - JOUR
T1 - Outcomes following SARS-CoV-2 infection in patients with chronic liver disease
T2 - An international registry study
AU - Marjot, Thomas
AU - Moon, Andrew M.
AU - Cook, Jonathan A.
AU - Abd-Elsalam, Sherief
AU - Aloman, Costica
AU - Armstrong, Matthew J.
AU - Pose, Elisa
AU - Brenner, Erica J.
AU - Cargill, Tamsin
AU - Catana, Maria Andreea
AU - Dhanasekaran, Renumathy
AU - Eshraghian, Ahad
AU - García-Juárez, Ignacio
AU - Gill, Upkar S.
AU - Jones, Patricia D.
AU - Kennedy, James
AU - Marshall, Aileen
AU - Matthews, Charmaine
AU - Mells, George
AU - Mercer, Carolyn
AU - Perumalswami, Ponni V.
AU - Avitabile, Emma
AU - Qi, Xialong
AU - Su, Feng
AU - Ufere, Nneka N.
AU - Wong, Yu Jun
AU - Zheng, Ming Hua
AU - Barnes, Eleanor
AU - Barritt, Alfred S.
AU - Webb, Gwilym J.
N1 - Funding Information:
The COVID-Hep.net registry is supported by the European Association for the Study of the Liver (EASL) (2020RG03). This work was also supported by the National Institutes of Health grant T32 DK007634 (AMM and EJB), and North Carolina Translational and Clinical Sciences Institute (CTSA grant number UL1TR002489). We acknowledge the support of the National Institutes of Health, through Grant Award Number UL1TR002489. TC was funded as an academic clinical fellow by NIHR and by WT training fellowship for clinicians (grant number 211042/Z/18/Z). EB is supported by the Oxford NIHR Biomedical Research Centre and is an NIHR Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
Funding Information:
The COVID-Hep.net registry is supported by the European Association for the Study of the Liver (EASL) ( 2020RG03 ). This work was also supported by the National Institutes of Health grant T32 DK007634 (AMM and EJB), and North Carolina Translational and Clinical Sciences Institute (CTSA grant number UL1TR002489 ). We acknowledge the support of the National Institutes of Health , through Grant Award Number UL1TR002489 . TC was funded as an academic clinical fellow by NIHR and by WT training fellowship for clinicians (grant number 211042/Z/18/Z). EB is supported by the Oxford NIHR Biomedical Research Centre and is an NIHR Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
Funding Information:
We conducted a multinational cohort study using an open online reporting form for patients with laboratory-confirmed SARS-CoV-2 and CLD. Data were collected between 25th March 2020 and 8th July 2020 through 2 collaborating online registries (SECURE-cirrhosis co-ordinated by University of North Carolina, Chapel Hill, USA and COVID-Hep.net co-ordinated by University of Oxford and supported by The European Association for the Study of the Liver). The registries were widely advertised through the communication channels of multiple endorsing gastroenterology and hepatology societies, direct emails to hepatology providers, and through social media. Submitting clinicians were asked to complete a case report form of clinical data at the end of their patient's disease course, defined as resolution of clinical signs of COVID-19, discharge from hospital, or death. A copy of the data collection tool is available in the supplementary information and was identical for both registries.
Publisher Copyright:
© 2020 European Association for the Study of the Liver
PY - 2021/3
Y1 - 2021/3
N2 - Background & Aims: Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined. Methods: Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network. Results: Mortality was 32% in patients with cirrhosis compared to 8% in those without (p <0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01–1.04), Child-Pugh A (OR 1.90; 1.03–3.52), B (OR 4.14; 2.4–7.65), or C (OR 9.32; 4.80–18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03–3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%–31.3%]) and C (+38.1% [27.1%–49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure. Conclusions: In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic. Lay summary: This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease.
AB - Background & Aims: Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined. Methods: Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network. Results: Mortality was 32% in patients with cirrhosis compared to 8% in those without (p <0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01–1.04), Child-Pugh A (OR 1.90; 1.03–3.52), B (OR 4.14; 2.4–7.65), or C (OR 9.32; 4.80–18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03–3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%–31.3%]) and C (+38.1% [27.1%–49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure. Conclusions: In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic. Lay summary: This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease.
KW - Acute-on-chronic liver failure
KW - COVID-19
KW - Chronic liver disease
KW - Cirrhosis
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85094681277&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2020.09.024
DO - 10.1016/j.jhep.2020.09.024
M3 - Article
C2 - 33035628
AN - SCOPUS:85094681277
SN - 0168-8278
VL - 74
SP - 567
EP - 577
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 3
ER -