Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study

Thomas Marjot, Andrew M. Moon, Jonathan A. Cook, Sherief Abd-Elsalam, Costica Aloman, Matthew J. Armstrong, Elisa Pose, Erica J. Brenner, Tamsin Cargill, Maria Andreea Catana, Renumathy Dhanasekaran, Ahad Eshraghian, Ignacio García-Juárez, Upkar S. Gill, Patricia D. Jones, James Kennedy, Aileen Marshall, Charmaine Matthews, George Mells, Carolyn MercerPonni V. Perumalswami, Emma Avitabile, Xialong Qi, Feng Su, Nneka N. Ufere, Yu Jun Wong, Ming Hua Zheng, Eleanor Barnes, Alfred S. Barritt, Gwilym J. Webb

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296 Scopus citations


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.

Original languageEnglish
Pages (from-to)567-577
Number of pages11
JournalJournal of Hepatology
Issue number3
StatePublished - Mar 2021


  • Acute-on-chronic liver failure
  • COVID-19
  • Chronic liver disease
  • Cirrhosis
  • SARS-CoV-2


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