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Meta-Analysis
. 2021 Oct;8(1):e000739.
doi: 10.1136/bmjgast-2021-000739.

Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies

Paul Middleton  1 , Catherine Hsu  2 , Mark P Lythgoe  3
Affiliations
Meta-Analysis

Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies

Paul Middleton et al. BMJ Open Gastroenterol. 2021 Oct.

Abstract

Background: COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed.

Objectives: To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection.

Design/method: PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model.

Results: 63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI: 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI: 1.36 to 2.42).

Conclusion: Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination.

Keywords: COVID-19; chronic liver disease; cirrhosis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of study selection process.
Figure 2
Figure 2
Meta-analysis of crude mortality OR comparing cirrhotic patients with COVID-19 with non-cirrhotic patients with COVID-19.
Figure 3
Figure 3
Funnel plot of studies included in the meta-analysis of crude mortality OR.
Figure 4
Figure 4
Meta-analysis of studies at lower risk of bias.
Figure 5
Figure 5
Meta-analysis of adjusted mortality OR in studies comparing cirrhotic inpatients with COVID-19 and non-cirrhotic inpatients with COVID-19.
See this image and copyright information in PMC

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