Long-term clinical outcomes of patients with COVID-19 and chronic liver disease: US multicenter COLD study

Abstract

Background: COVID-19 is associated with higher morbidity and mortality in patients with chronic liver diseases (CLDs). However, our understanding of the long-term outcomes of COVID-19 in patients with CLD is limited. Methods: We conducted a multicenter, observational cohort study of adult patients with CLD who were diagnosed with COVID-19 before May 30, 2020, to determine long-term clinical outcomes. We used a control group of patients with CLD confirmed negative for COVID-19. Results: We followed 666 patients with CLD (median age 58 years, 52.8% male) for a median of 384 (interquartile range: 31–462) days. The long-term mortality was 8.1%; with 3.6% experiencing delayed COVID-19-related mortality. Compared to a propensity-matched control group of patients with CLD without COVID-19 (n=1332), patients with CLD with COVID-19 had worse long-term survival [p<0.001; hazards ratio (HR): 1.69; 95% CI: 1.19–2.41] and higher rate of hospitalization (p<0.001, HR: 2.00, 1.62–2.48) over a 1-year follow-up period. Overall, 29.9% of patients reported symptoms of long-COVID-19. On multivariable analysis, female sex (p=0.05, HR: 2.45, 1.01–2.11), Hispanic ethnicity (p=0.003, HR: 1.94, 1.26–2.99), and severe COVID-19 requiring mechanical ventilation (p=0.028, HR: 1.74, 1.06–2.86) predicted long-COVID-19. In survivors, liver-related laboratory parameters showed significant improvement after COVID-19 resolution. COVID-19 vaccine status was available for 72% (n=470) of patients with CLD and history of COVID-19, of whom, 70% (n=326) had received the COVID-19 vaccine. Conclusions: Our large, longitudinal, multicenter study demonstrates a high burden of long-term mortality and morbidity in patients with CLD and COVID-19. Symptoms consistent with long-COVID-19 were present in 30% of patients with CLD. These results illustrate the prolonged implications of COVID-19 both for recovering patients and for health care systems.

COVID-19 and the Liver: A Complex and Evolving Picture

“…A 1-year long follow-up study, involving patients with CLD with a history of COVID-19 and a propensity matched control group without a history, reported a significant increase in all-cause mortality (8.0% vs 2.0%) and higher rates of hospitalisation (34% vs 21%) in the patients who had had COVID. 81 Comparable minorities of the patients had compensated (17.2%) and decompensated (5.5%) cirrhosis at baseline; cirrhosis was, however, an independent predictors of overall survival and hospitalisation. Seventy percent of the patients with a history of COVID-19 had received at least one dose of a COVID-19 vaccine.…”

“…Seventy percent of the patients with a history of COVID-19 had received at least one dose of a COVID-19 vaccine. 81 People infected with COVID-19 can experience long-lasting debilitating symptoms. The term "long-COVID-19" is used to describe "physical, medical, and cognitive symptom lasting for at least 2 months following COVID-19 infection, for which there is no other explanation".…”

“…82 A year-long follow-up study of patients with CLD 30% reported symptoms of long-COVID-19. 81 There is clear evidence of a legacy of adverse behavioural change following the pandemic. 81 Thus, in a long-term follow-up study involving patients with CLD who had COVID-19, a third of whom had been actively drinking prior to the diagnosis of COVID-19, a similar proportion reported active moderate to heavy alcohol use after recovery, whilst 4% reporting increased alcohol use and 1.7% de novo alcohol use.…”

“…81 There is clear evidence of a legacy of adverse behavioural change following the pandemic. 81 Thus, in a long-term follow-up study involving patients with CLD who had COVID-19, a third of whom had been actively drinking prior to the diagnosis of COVID-19, a similar proportion reported active moderate to heavy alcohol use after recovery, whilst 4% reporting increased alcohol use and 1.7% de novo alcohol use. Weight gain was noted in 23% of these patients with a median gain of 10 pounds (4.5 Kg); control data were not available.…”

The global challenges of the long COVID-19 in adults and children

“…Additionally, when patients have underlying chronic comorbidities, the outcomes would be worse. A recent large study of adult patients with chronic liver disease who were diagnosed with COVID-19 before May 2020, found that symptoms consistent with long-COVID-19 were present in 30% of patients with chronic liver disease [ 44 ]. Different studies have also demonstrated significant and long-lasting neurological manifestations [ 45 , 46 ].…”