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

Iavarone, M.; D’Ambrosio, Roberta; Soria, Alessandro; Triolo, Michela; Pugliese, Nicola Riccardo; Poggio, P. Del; Perricone, Giovanni; Massironi, Sara; Spinetti, Angiola; Buscarini, Elisabetta; Viganò, Mauro; Carriero, Canio; Fagiuoli, S.; Aghemo, Alessio; Belli, Luca; Luca, Martina De; Pedaci, Marianna; Rimondi, Alessandro; Rumi, Maria Grazia; Invernizzi, Pietro; Bonfanti, Paolo; Lampertico, Pietro

doi:10.1016/j.jhep.2020.06.001

Cited by 333 publications

(524 citation statements)

References 19 publications

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“…Their data suggest that the odds of developing severe COVID‐19, based on respiratory parameters, were not significantly different between CLD and non‐CLD patients. The poor outcome of COVID‐19 in patients with cirrhosis is well known 2‐4 . However, only 11.6% of 250 CLD patients (n = 29) in the current study had cirrhosis.…”

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confidence: 57%

Letter: elevated liver enzymes and outcome in COVID‐19

Elhence

Kumar

Shalimar

2020

Aliment Pharmacol Ther

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confidence: 57%

Letter: elevated liver enzymes and outcome in COVID‐19

Elhence

Kumar

Shalimar

2020

Aliment Pharmacol Ther

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“…A recent study looking at cirrhotic patients with COVID-19 infection showed that mortality correlated strongly with baseline CTP class and MELD score, with a greater proportion of patients with CTP-C liver cirrhosis dying 7 . Other authors have found that patients with advanced liver cirrhosis did poorer with COVID-19 infection [33][34] . We postulate that our 3 cirrhotic patients ran a milder COVID-19 clinical course possibly from the absence of NAFLD and that 2 of 3 were CTP-A at baseline.…”

Section: Discussionmentioning

confidence: 90%

Chronic Liver Disease and COVID-19: A Perspective From Singapore

Kuang

Lin

Chew

et al. 2020

Preprint

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Background: Chronic liver diseases including non-alcoholic fatty liver disease (NAFLD) are associated with COVID-19 progression. With no signs of the pandemic abating, thousands worldwide are at risk of a severe disease course. Objective: We aimed to describe the epidemiological features, clinical course, treatment and outcomes of our patients with COVID-19 and chronic liver disease.Methods: A retrospective descriptive study of COVID-19 patients with chronic liver disease admitted to the National Centre for Infectious Diseases in Singapore between 29th February and 2nd May 2020 was performed. Results: 16 patients had chronic liver disease – 9 had NAFLD. In the NAFLD group, peak ALT was higher (median: 84 U/L vs 38 U/L; P = 0.042) and more patients had hyperlipidaemia (88.9% vs 28.6%; p=0.035), but median Body Mass Index (BMI) was not significantly higher (24.3 kg/m2 vs 24.2 kg/m2). NAFLD patients had a poorer clinical course: more required anti-viral medications (66.7% vs 0%; p=0.011), and time to negative swab was longer (24 days vs 13 days; p=0.008). 3 patients had liver cirrhosis (all non-NAFLD). 1 decompensated but none required intensive care unit admission or died.Conclusion: Our results show that in COVID-19 patients with chronic liver disease, those with NAFLD experience a more severe clinical course. In Asians, NAFLD can have poorer prognostic implications, despite them having only mildly raised BMI. We advocate that patients with NAFLD and liver cirrhosis should be closely monitored for COVID-19 disease progression.

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“…The higher mortality rates in COVID-19 patients could possibly could be because of extrahepatic organ failures especially respiratory failure. The severity of lung injury and CLIF-C have been associated with poor outcomes in COVID-19 patients with cirrhosis [16]. Pulmonary vascular changes including capillary microthrombi, are common in patients with COVID-19 [17].…”

Section: Discussionmentioning

confidence: 99%

“…Whether SARS-CoV-2 infection outcomes are similar to other acute precipitants, including bacterial infection in patients developing ACLF, is unclear. A recent study reported poor outcomes in COVID-19 positive patients as compared to those with bacterial infection [16]. The de nite management of ACLF is LT.…”

Section: Discussionmentioning

confidence: 99%

Poor Outcomes in Patients with Cirrhosis and COVID-19

Shalimar

Elhence

Vaishnav

et al. 2020

Preprint

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Abstract Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease 2019(COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure(ACLF) were included. The etiology of cirrhosis was alcohol(n=9), non-alcoholic fatty liver disease(n=2), viral(n=5), autoimmune hepatitis(n=4), and cryptogenic cirrhosis(n=6). The clinical presentations included complications of cirrhosis in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

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

Cited by 333 publications

References 19 publications

Letter: elevated liver enzymes and outcome in COVID‐19

Letter: elevated liver enzymes and outcome in COVID‐19

Chronic Liver Disease and COVID-19: A Perspective From Singapore

Poor Outcomes in Patients with Cirrhosis and COVID-19

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