High rates of 30-day mortality in patients with cirrhosis and COVID-19

JOURNAL OF HEPATOLOGY

卷:73

Article

Iavarone, Massimo¹  D'Ambrosio, Roberta¹  Soria, Alessandro²  Triolo, Michela³  Pugliese, Nicola^4,5  Del Poggio, Paolo⁶  Perricone, Giovanni⁷  Massironi, Sara^8,9,10  Spinetti, Angiola^11,12  Buscarini, Elisabetta¹³  Vigano, Mauro¹⁴  Carriero, Canio^11,12  Fagiuoli, Stefano³  Aghemo, Alessio^4,5  Belli, Luca S.⁷  Luca, Martina^8,9  Pedaci, Marianna^13,15  Rimondi, Alessandro^1,15  Rumi, Maria Grazia^14,15  Invernizzi, Pietro^8,9,10  Bonfanti, Paolo²  Lampertico, Pietro^1,16 

[1] Fdn IRCCS Ca Granda Osped Maggiore Policlin, CRC AM & A Migliavacca Ctr Liver Dis, Div Gastroenterol & Hepatol, Via F Sforza 28, I-20122 Milan, Italy

[2] Univ Milano Bicocca, San Gerardo Hosp, Div Infect Dis, ASST Monza,Sch Med, Monza, Italy

[3] ASST Papa Giovanni XXIII, Gastroenterol Hepatol Transplantol 1, Bergamo, Italy

[4] Humanitas Clin & Res Ctr IRCCS, Dept Gastroenterol, Div Internal Med & Hepatol, Rozzano, MI, Italy

[5] Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, MI, Italy

[6] Policlin S Marco, UO Gastroenterol, Zingonia Bergamo, Italy

[7] Osped Niguarda Ca Granda, Hepatol & Gastroenterol Unit, Milan, Italy

[8] Univ Milano Bicocca, Div Gastroenterol, Monza, Italy

[9] Univ Milano Bicocca, Ctr Autoimmune Liver Dis, Dept Med & Surg, Monza, Italy

[10] San Gerardo Hosp, European Reference Network Hepatol Dis ERN RARE L, Monza, Italy

[11] Univ Brescia, Dept Infect & Trop Dis, Brescia, Italy

[12] ASST Spedali Civili Gen Hosp, Brescia, Italy

[13] ASST Osped Maggiore, UOC Gastroenterol & Endoscopia Digest, Crema, Italy

[14] Osped San Giuseppe, Div Hepatol, Milan, Italy

[15] Univ Milan, Milan, Italy

[16] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy

关键词: Liver transplantation;    Hepatocellular carcinoma;    SARS-CoV-2;    Hepatitis;    HBV;    HCV;   

DOI  :  10.1016/j.jhep.2020.06.001

来源: Elsevier

【 摘 要 】

Background & Aims: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. Methods: In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. Results: Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virusrelated, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/ polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score >-15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. Conclusion: COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. Lay summary: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free