Hepatology . Post-Vaccination COVID-19 Infection is Associated with Reduced Mortality in Patients With Cirrhosis

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Hepatology


. 2022 Jan 12.
doi: 10.1002/hep.32337. Online ahead of print.
Post-Vaccination COVID-19 Infection is Associated with Reduced Mortality in Patients With Cirrhosis


Binu V John ^{1 2} , Yangyang Deng ³ , Kaley B Schwartz ¹ , Tamar H Taddei ^{4 5} , David E Kaplan ^{6 7} , Paul Martin ^{1 2} , Hann-Hsiang Chao ⁸ , Bassam Dahman ³



Affiliations

• PMID: 35023206
• DOI: 10.1002/hep.32337

Abstract

Background and aims: Patients develop breakthrough coronavirus disease 2019 (COVID-19) infection despite vaccination. The aim of this study was to identify outcomes in patients with cirrhosis who developed post-vaccination COVID-19.
Methods: We performed a retrospective cohort study among US Veterans with cirrhosis and post-vaccination or unvaccinated COVID-19. Patients were considered fully vaccinated if COVID-19 was diagnosed 14 days after the second dose of either the Pfizer BNT162b2, Moderna 1273-mRNA, or the single dose Janssen Ad.26.COV2.S vaccines, and partially vaccinated if COVID-19 was diagnosed 7 days after the first dose of any vaccine but prior to full vaccination. We investigated the association of post-vaccination COVID-19 with mortality.
Results: We identified 3242 unvaccinated and 254 post-vaccination COVID-19 patients with cirrhosis (82 after full and 172 after partial vaccination). In a multivariable analysis of a 1:2 propensity-matched cohort including vaccinated (n=254) and unvaccinated (n=508) participants, post-vaccination COVID-19 was associated with reduced risk of death (aHR 0.21, 95% CI 0.11-0.42). The reduction was observed after both full (aHR 0.22, 95% CI 0.08-0.63) and partial vaccination (aHR 0.19, 95% CI 0.07-0.54), following the 1273-mRNA (aHR 0.12, 95% CI 0.04-0.37) and BNT 162b2 vaccines (aHR 0.27, 95% CI 0.10-0.71), and among patients with compensated (aHR 0.19, 95% CI 0.08-0.45) and decompensated cirrhosis (aHR 0.27, 95% CI 0.08-0.90). Findings were consistent in a sensitivity analysis restricted to participants who developed COVID-19 after vaccine availability.
Conclusion: Though patients with cirrhosis can develop breakthrough COVID-19 after full or partial vaccination, these infections are associated with reduced mortality.