tetano
Editor, Senior Moderator
Clin Gastroenterol Hepatol
. 2020 Sep 17;S1542-3565(20)31288-X.
doi: 10.1016/j.cgh.2020.09.027. Online ahead of print.
Predictors of Outcomes of COVID-19 in Patients with Chronic Liver Disease: US Multi-center Study
Donghee Kim[SUP] 1 [/SUP], Nia Adeniji[SUP] 1 [/SUP], Nyann Latt[SUP] 2 [/SUP], Sonal Kumar[SUP] 3 [/SUP], Patricia P Bloom[SUP] 4 [/SUP], Elizabeth S Aby[SUP] 5 [/SUP], Ponni Perumalswami[SUP] 6 [/SUP], Marina Roytman[SUP] 7 [/SUP], Michael Li[SUP] 8 [/SUP], Alexander S Vogel[SUP] 8 [/SUP], Andreea M Catana[SUP] 9 [/SUP], Kara Wegermann[SUP] 10 [/SUP], Rotonya M Carr[SUP] 11 [/SUP], Costica Aloman[SUP] 12 [/SUP], Vincent Chen[SUP] 13 [/SUP], Atoosa Rabiee[SUP] 14 [/SUP], Brett Sadowski[SUP] 15 [/SUP], Veronica Nguyen[SUP] 16 [/SUP], Winston Dunn[SUP] 17 [/SUP], Kenneth Chavin[SUP] 18 [/SUP], Kali Zhou[SUP] 19 [/SUP], Blanca Lizaola-Mayo[SUP] 20 [/SUP], Akshata Moghe[SUP] 21 [/SUP], Jos? Debes[SUP] 5 [/SUP], Tzu-Hao Lee[SUP] 10 [/SUP], Andrea Branch[SUP] 6 [/SUP], Kathleen Viveiros[SUP] 8 [/SUP], Walter Chan[SUP] 8 [/SUP], David Chascsa[SUP] 20 [/SUP], Paul Kwo[SUP] 22 [/SUP], Renumathy Dhanasekaran[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19).
Methods: We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD.
Results: Of the 978 patients in our cohort, 867 patients (mean age 56.9?14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio
2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19.
Conclusions: The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19.
Keywords: Alcohol; COVID-19; Cirrhosis; Mortality.
. 2020 Sep 17;S1542-3565(20)31288-X.
doi: 10.1016/j.cgh.2020.09.027. Online ahead of print.
Predictors of Outcomes of COVID-19 in Patients with Chronic Liver Disease: US Multi-center Study
Donghee Kim[SUP] 1 [/SUP], Nia Adeniji[SUP] 1 [/SUP], Nyann Latt[SUP] 2 [/SUP], Sonal Kumar[SUP] 3 [/SUP], Patricia P Bloom[SUP] 4 [/SUP], Elizabeth S Aby[SUP] 5 [/SUP], Ponni Perumalswami[SUP] 6 [/SUP], Marina Roytman[SUP] 7 [/SUP], Michael Li[SUP] 8 [/SUP], Alexander S Vogel[SUP] 8 [/SUP], Andreea M Catana[SUP] 9 [/SUP], Kara Wegermann[SUP] 10 [/SUP], Rotonya M Carr[SUP] 11 [/SUP], Costica Aloman[SUP] 12 [/SUP], Vincent Chen[SUP] 13 [/SUP], Atoosa Rabiee[SUP] 14 [/SUP], Brett Sadowski[SUP] 15 [/SUP], Veronica Nguyen[SUP] 16 [/SUP], Winston Dunn[SUP] 17 [/SUP], Kenneth Chavin[SUP] 18 [/SUP], Kali Zhou[SUP] 19 [/SUP], Blanca Lizaola-Mayo[SUP] 20 [/SUP], Akshata Moghe[SUP] 21 [/SUP], Jos? Debes[SUP] 5 [/SUP], Tzu-Hao Lee[SUP] 10 [/SUP], Andrea Branch[SUP] 6 [/SUP], Kathleen Viveiros[SUP] 8 [/SUP], Walter Chan[SUP] 8 [/SUP], David Chascsa[SUP] 20 [/SUP], Paul Kwo[SUP] 22 [/SUP], Renumathy Dhanasekaran[SUP] 1 [/SUP]
Affiliations
- PMID: 32950749
- DOI: 10.1016/j.cgh.2020.09.027
Abstract
Background: Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19).
Methods: We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD.
Results: Of the 978 patients in our cohort, 867 patients (mean age 56.9?14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio
2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19.
Conclusions: The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19.
Keywords: Alcohol; COVID-19; Cirrhosis; Mortality.