Poor outcomes in patients with cirrhosis and Corona Virus Disease-19

Indian J Gastroenterol. 2020 Jun;39(3):285-291. doi: 10.1007/s12664-020-01074-3. Epub 2020 Aug 15.

Abstract

Background and aim: There is a paucity of data on the clinical presentations and outcomes of Corona Virus Disease-19 (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.

Methods: Patients with known chronic liver disease who presented with superimposed COVID-19 (n = 28) between 22 April 2020 and 22 June 2020 were studied. Seventy-eight cirrhotic patients without COVID-19 were included as historical controls for comparison.

Results: A total of 28 COVID-19 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 with 23.1% (18/78) in the historical controls (p = 0.077). All COVID-19 patients with ACLF (9/9) died compared with 53.3% (16/30) in ACLF of historical controls (p = 0.015). Mortality rate was higher in COVID-19 patients with compensated cirrhosis and AD as compared with 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.

Conclusion: COVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

Keywords: Acute decompensation; COVID-19; Chronic liver disease; Hepatic failure; Inflammation; Liver; Liver function tests; Pandemic; SARS-CoV-2; Acute-on-chronic liver failure.

MeSH terms

  • Acute-On-Chronic Liver Failure* / diagnosis
  • Acute-On-Chronic Liver Failure* / mortality
  • Acute-On-Chronic Liver Failure* / virology
  • Betacoronavirus / isolation & purification*
  • COVID-19
  • Cohort Studies
  • Comorbidity
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / mortality
  • Coronavirus Infections* / physiopathology
  • Disease Progression
  • Female
  • Humans
  • India / epidemiology
  • Length of Stay / statistics & numerical data
  • Liver Cirrhosis* / diagnosis
  • Liver Cirrhosis* / epidemiology
  • Liver Cirrhosis* / etiology
  • Liver Cirrhosis* / virology
  • Male
  • Middle Aged
  • Mortality
  • Outcome Assessment, Health Care
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / mortality
  • Pneumonia, Viral* / physiopathology
  • Prognosis
  • Risk Factors
  • SARS-CoV-2