COVID-19 has rapidly become a global challenge. 1 We read with interest the article by Bezzio et al 1 that reported the characteristics and outcomes of COVID-19 patients with pre-existing IBD. Patients with pre-existing cirrhosis, who have immune dysfunction and poorer outcomes from acute respiratory distress syndrome (ARDS) than patients without cirrhosis, are also considered a high-risk population for COVID-19. 2 3 In previous studies, the proportion of COVID-19 patients with pre-existing liver conditions ranged from 2% to 11%. 2 However, the clinical course and risk factors for mortality in these patients has not yet been reported. This retrospective multicentre study (COVID-Cirrhosis-CHESS, ClinicalTrials. gov NCT04329559) included consecutive adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pre-existing cirrhosis from 16 designated hospitals in China between 31 December 2019 and 24 March 2020. Patient characteristics are summarised in table 1. Twenty-one COVID-19 patients with preexisting cirrhosis (Child-Pugh class A, B and C in 16, 3 and 2 patients, respectively) were included in the analysis. The median age was 68 years; 11 (52.4%) were male. Most patients had compensated cirrhosis (81.0%) and chronic HBV infection was the most common aetiology (57.1%). Comorbidities other than cirrhosis were present in most patients (66.7%). In previous studies, older age, male sex and pre-existing comorbidities were associated with higher risk of mortality for COVID-19. 4 5 Here, there were no significant differences between survivors (n=16) and non-survivors (n=5) in age, sex, comorbidities, aetiology of cirrhosis, stage of cirrhosis, Child-Pugh class, Model for End-stage Liver Disease (MELD) score, interval between onset and admission, or onset symptoms of COVID-19. Comorbidities have been associated with adverse outcomes in cirrhosis, 6 but our analysis did not show clear prognostic associations-possibly due to the small size and narrow composition of the study population.

2 6 Sweden 2 7 2 8 Abstract = 186 words, Main text = 1722 words, Figures =2. Abstract 3 0 Objectives: Comorbidities have significant indications for the disease outcome of COVID-19, 3 1 however which underlying diseases that contribute the most to aggravate the conditions of 3 2 COVID-19 patients is still largely unknown. SARS-CoV-2 viral clearance is a golden standard 3 3 for defining the recovery of COVID-19 infections. To dissect the underlying diseases that 3 4 could impact on viral clearance, we enrolled 106 COVID-19 patients who were hospitalized in 3 5 Methodology: We comprehensively analyzed demographic, clinical and laboratory data, as 3 8 well as patient treatment records. Survival analyses with Kaplan-Meier and Cox regression 3 9 modelling were employed to identify factors influencing the viral clearance negatively. 4 0 Results: We found that increasing age, male gender, and angiotensin-converting enzyme 2 4 1 (ACE2) associated factors (including hypertension, diabetes, and cardiovascular diseases) 4 2 adversely affected the viral clearance. Furthermore, analysis by a random forest survival 4 3 model pointed out hypertension, cortisone treatment, gender, and age as the four most 4 4 important variables. 4 5 Conclusions: We conclude that patients at old age, males, and/or having diseases 4 6 associated with high expression of ACE2 will have worse prognosis during a COVID-19 4 7 infections. 4 8 4 9

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