Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study

JOURNAL OF HEPATOLOGY

卷:74

Article

Marjot, Thomas¹  Moon, Andrew M.²  Cook, Jonathan A.³  Abd-Elsalam, Sherief⁴  Aloman, Costica⁵  Armstrong, Matthew J.⁶  Pose, Elisa^7,8,9  Brenner, Erica J.¹⁰  Cargill, Tamsin¹  Catana, Maria-Andreea¹¹  Dhanasekaran, Renumathy¹²  Eshraghian, Ahad¹³  Garcia-Juarez, Ignacio¹⁴  Gill, Upkar S.^15,16  Jones, Patricia D.¹⁷  Kennedy, James¹  Marshall, Aileen¹⁸  Matthews, Charmaine¹⁹  Mells, George²⁰  Mercer, Carolyn¹  Perumalswami, Ponni, V²¹  Avitabile, Emma^7,8  Qi, Xialong²²  Su, Feng²³  Ufere, Nneka N.²⁴  Wong, Yu Jun^25,26  Zheng, Ming-Hua^27,28  Barnes, Eleanor¹  Barritt, Alfred S.²  Webb, Gwilym J.^1,20 

[1] Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Oxford Liver Unit, Translat Gastroenterol Unit, Oxford, England

[2] Univ N Carolina, Div Gastroenterol & Hepatol, Chapel Hill, NC USA

[3] Univ Oxford, Ctr Stat Med, Oxford, England

[4] Tanta Univ, Trop Med & Infect Dis Dept, Tanta, Egypt

[5] Rush Univ, Dept Med, Sect Hepatol, Med Ctr, Chicago, IL USA

[6] Queen Elizabeth Hosp Birmingham, Liver Unit, Birmingham, W Midlands, England

[7] Hosp Clinic, Liver Unit, Barcelona, Spain

[8] Inst Investc Biom Diques August Pi i Sunyer, Barcelona, Spain

[9] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain

[10] Univ N Carolina, Div Pediat Gastroenterol & Hepatol, Chapel Hill, NC 27515 USA

[11] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Med, Div Gastroenterol Hepatol, Boston, MA USA

[12] Stanford Univ, Dept Med, Div Gastroenterol & Hepatol, Sch Med, Palo Alto, CA USA

[13] Abu Ali Sina Hosp, Shiraz Transplant Ctr, Shiraz, Iran

[14] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Gastroenterol, Mexico City, DF, Mexico

[15] Barts Hlth NHS Trust, Barts Liver Ctr, London, England

[16] London Sch Med & Dent, QMUL, London, England

[17] Univ Miami, Dept Med, Div Digest Hlth & Liver Dis, Miller Sch Med, Miami, FL USA

[18] Royal Free Hosp, Sheila Sherlock Liver Unit, London, England

[19] Liverpool Univ Hosp NHS Fdn Trust, Royal Liverpool Hosp, Dept Gastroenterol & Hepatol, Liverpool, Merseyside, England

[20] Cambridge Univ Hosp, Addenbrooke S Hosp, Cambridge Liver Unit, Cambridge, England

[21] Icahn Sch Med Mt Sinai, Dept Med, Div Liver Dis, New York, NY USA

[22] Lanzhou Univ, Chess Ctr, Inst Portal Hypertens, Hosp 1, Lanzhou, Gansu, Peoples R China

[23] Univ Washington, Div Gastroenterol, Seattle, WA USA

[24] Harvard Med Sch, Liver Ctr, Massachusetts Gen Hosp, Gastrointestinal Div, Boston, MA USA

[25] Changi Gen Hosp, Dept Gastroenterol & Hepatol, Singapore, Singapore

[26] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore

[27] Wenzhou Med Univ, MAFLD Res Ctr, Dept Hepatol, Affiliated Hosp 1, Wenzhou, Zhejiang, Peoples R China

[28] Key Lab Diag & Treatment Dev Chron Liver Dis, Wenzhou, Zhejiang, Peoples R China

关键词: SARS-CoV-2;    COVID-19;    Chronic liver disease;    Cirrhosis;    Acute-on-chronic liver failure;   

DOI  :  10.1016/j.jhep.2020.09.024

来源: Elsevier

【 摘 要 】

Background & Aims: Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined. Methods: Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network. Results: Mortality was 32% in patients with cirrhosis compared to 8% in those without (p < 0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01-1.04), Child-Pugh A (OR 1.90; 1.03-3.52), B (OR 4.14; 2.4-7.65), or C (OR 9.32; 4.80-18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03-3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%-31.3%]) and C (+38.1% [27.1%- 49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure. Conclusions: In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic. Lay summary: This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V.

【 授权许可】

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