High rates of 30-day mortality in patients with cirrhosis and COVID-19

J Hepatol. 2020 Nov;73(5):1063-1071. doi: 10.1016/j.jhep.2020.06.001. Epub 2020 Jun 9.

Abstract

Background & aims: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis.

Methods: In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records.

Results: Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections.

Conclusion: COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis.

Lay summary: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.

Keywords: HBV; HCV; Hepatitis; Hepatocellular carcinoma; Liver transplantation; SARS-CoV-2.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / adverse effects
  • Betacoronavirus / isolation & purification
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / methods
  • Comorbidity
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / mortality
  • Coronavirus Infections* / physiopathology
  • Female
  • Humans
  • Italy / epidemiology
  • Liver Cirrhosis* / diagnosis
  • Liver Cirrhosis* / epidemiology
  • Liver Cirrhosis* / physiopathology
  • Liver Function Tests* / methods
  • Liver Function Tests* / statistics & numerical data
  • Male
  • Mortality
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / mortality
  • Pneumonia, Viral* / physiopathology
  • Pneumonia, Viral* / virology
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2

Substances

  • Antiviral Agents