Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

Abstract

Background/Aims: The impact of liver cirrhosis on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between liver cirrhosis and the development of severe complications from COVID-19. Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus-2. Patients with liver cirrhosis who were infected with COVID-19 (n=67, LC+ COVID+) were matched with those with cirrhosis only (n=332, LC+ COVID-) and those with COVID-19 only (n=333, LC-COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications. Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC-COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC-COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19. Conclusions: Our study suggests that liver cirrhosis was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

Patients with cirrhosis during the COVID-19 pandemic: Current evidence and future perspectives

“…Decompensated liver cirrhosis was identified as an independent risk factor for mortality[ 21 ]; patients with cirrhosis are also at higher risk of COVID-19-related hospitalization and mortality[ 20 ]. Compared with other studies, cirrhosis was not found to be associated with mortality in COVID-19 patients in a Korean nationwide population-based study[ 28 ]. The authors also demonstrated a substantially lower risk of mortality and other complications in patients with cirrhosis and COVID-19[ 28 ].…”

“…Studies involving patients with cirrhosis and COVID-19 showed that the proportion of patients who developed AD ranged widely from 9.3% to 61.5% (Table 1 )[ 14 , 18 , 19 , 21 , 30 ]. The decompensation events included hepatic encephalopathy (4.5% to 27%)[ 14 , 18 , 19 , 21 , 23 , 28 , 31 ], variceal bleeding (1% to 30.8%)[ 14 , 18 , 19 , 21 , 23 , 28 , 30 , 32 , 33 ], worsening ascites (3% to 28%)[ 14 , 18 , 19 , 21 , 28 , 30 , 31 , 33 ], spontaneous bacterial peritonitis (2.9% to 7%)[ 14 , 18 , 19 ], jaundice (23.3%)[ 14 ], and secondary infection (7.1%)[ 22 ]. Moreover, the development of ACLF was reported in 4.8% to 34.6% of patients with cirrhosis and COVID-19[ 14 , 18 , 23 , 30 - 33 ].…”

“…Pre-existing cirrhosis was found to be a risk factor for severe COVID-19[ 14 ]. Furthermore, cirrhotic patients are also more likely to develop complications of COVID-19, including ARDS (28.6% to 52%)[ 22 , 31 - 33 ], respiratory failure requiring mechanical ventilation (MV) (4% to 38%)[ 14 , 18 , 19 , 22 , 23 , 31 - 33 ], shock (6% to 30%)[ 14 , 22 , 23 , 28 , 31 - 33 ], renal failure requiring renal replacement therapy (1.5% to 19%)[ 18 , 19 , 22 , 23 , 28 , 33 ], the need for extracorporeal membrane oxygenation (9.5%)[ 33 ], and the need for intensive care unit (ICU) admission (3% to 43%) (Table 2 )[ 14 , 18 , 19 , 22 , 23 , 28 , 31 - 33 ]. It is noteworthy that far greater proportions of COVID-19 patients developed an adverse outcome than receiving the corresponding level of care ( i.e.…”

“…Compared with the general population with COVID-19, patients with cirrhosis and COVID-19 had higher mortality rates, ranging from 9% to 42.3% (Table 2 )[ 14 , 18 , 19 , 21 - 23 , 28 , 30 - 33 ]. Decompensated liver cirrhosis was identified as an independent risk factor for mortality[ 21 ]; patients with cirrhosis are also at higher risk of COVID-19-related hospitalization and mortality[ 20 ].…”

“…Whether patients with human immunodeficiency virus infection are at higher risk of mortality due to COVID-19 is unclear[ 24 , 26 , 27 ]. In addition to studies involving the aforementioned immunocompromised patients, there have been several studies investigating the clinical and biochemical characteristics related to the prognosis of COVID-19 in cirrhotic patients, yielding some preliminary conclusions[ 23 , 28 - 33 ]. In this review, we summarized the current epidemiology, clinical characteristics, liver injury pathophysiology, outcomes, and management strategies in patients with cirrhosis and COVID-19.…”