Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Mar;70(3):531-536.
doi: 10.1136/gutjnl-2020-322118. Epub 2020 Jul 13.

Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort

Jasmohan S Bajaj  1   2 , Guadalupe Garcia-Tsao  3 , Scott W Biggins  4 , Patrick S Kamath  5 , Florence Wong  6 , Sara McGeorge  2 , Jawaid Shaw  2 , Meredith Pearson  4 , Micheal Chew  3 , Andrew Fagan  2 , Randolph de la Rosa Rodriguez  3 , Janelle Worthington  5 , Amy Olofson  5 , Vanessa Weir  7 , Calvin Trisolini  7 , Sarah Dwyer  7 , K Rajender Reddy  7   8
Affiliations
Comparative Study

Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort

Jasmohan S Bajaj et al. Gut. 2021 Mar.

Abstract

Objective: Comorbid conditions are associated with poor prognosis in COVID-19. Registry data show that patients with cirrhosis may be at high risk. However, outcome comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone and cirrhosis alone are lacking. The aim of this study was to perform these comparisons.

Design: A multicentre study of inpatients with cirrhosis+COVID-19 compared with age/gender-matched patients with COVID-19 alone and cirrhosis alone was performed. COVID-19 and cirrhosis characteristics, development of organ failures and acute-on-chronic liver failure (ACLF) and mortality (inpatient death+hospice) were compared.

Results: 37 patients with cirrhosis+COVID-19 were matched with 108 patients with COVID-19 and 127 patients with cirrhosis from seven sites. Race/ethnicity were similar. Patients with cirrhosis+COVID-19 had higher mortality compared with patients with COVID-19 (30% vs 13%, p=0.03) but not between patients with cirrhosis+COVID-19 and patients with cirrhosis (30% vs 20%, p=0.16). Patients with cirrhosis+COVID-19 versus patients with COVID-19 alone had equivalent respiratory symptoms, chest findings and rates of intensive care unit transfer and ventilation. However, patients with cirrhosis+COVID-19 had worse Charlson Comorbidity Index (CCI 6.5±3.1 vs 3.3±2.5, p<0.001), lower presenting GI symptoms and higher lactate. Patients with cirrhosis alone had higher cirrhosis-related complications, maximum model for end-stage liver disease (MELD) score and lower BiPAP/ventilation requirement compared with patients with cirrhosis+COVID-19, but CCI and ACLF rates were similar. In the entire group, CCI (OR 1.23, 95% CI 1.11 to 1.37, p<0.0001) was the only variable predictive of mortality on multivariable regression.

Conclusions: In this multicentre North American contemporaneously enrolled study, age/gender-matched patients with cirrhosis+COVID-19 had similar mortality compared with patients with cirrhosis alone but higher than patients with COVID-19 alone. CCI was the only independent mortality predictor in the entire matched cohort.

Keywords: chronic liver disease; cirrhosis; infectious disease; liver cirrhosis; sepsis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of patient recruitment and matching.
Figure 2
Figure 2
Mortality (in-hospital mortality and hospice) comparison between groups.
See this image and copyright information in PMC

Comment in

References

    1. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. . Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med 2020;382:2012–22. 10.1056/NEJMoa2004500 - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention People of any age with underlying medical conditions. Available: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-...
    1. Qi X, Liu Y, Wang J, et al. . Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: a multicentre cohort study. Gut 2020;5:gutjnl-2020-321666. 10.1136/gutjnl-2020-321666 - DOI - PMC - PubMed
    1. Moon AM, Webb GJ, Aloman C, et al. . High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: Preliminary results from an international registry. J Hepatol 2020. doi:10.1016/j.jhep.2020.05.013. [Epub ahead of print: 21 May 2020]. - DOI - PMC - PubMed
    1. Pereira MR, Mohan S, Cohen DJ, et al. . COVID-19 in solid organ transplant recipients: initial report from the US EpiCenter. Am J Transplant 2020;20:1800–8. 10.1111/ajt.15941 - DOI - PMC - PubMed