tetano
Editor, Senior Moderator
J Clin Exp Hepatol
. 2021 Nov 24.
doi: 10.1016/j.jceh.2021.11.009. Online ahead of print.
The Outcome after Hospital Discharge in Cirrhosis is Not Worsened with COVID-19 Infection: A Propensity Score-matched Analysis
Manas Vaishnav[SUP] 1 [/SUP], Anshuman Elhence[SUP] 1 [/SUP], Sagnik Biswas[SUP] 1 [/SUP], Piysuh Pathak[SUP] 1 [/SUP], Abhinav Anand[SUP] 1 [/SUP], Sabreena Sheikh[SUP] 1 [/SUP], Vishwajeet Singh[SUP] 2 [/SUP], Souvik Maitra[SUP] 3 [/SUP], Amit Goel[SUP] 4 [/SUP], Shalimar[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Patients with cirrhosis and coronavirus disease-2019 (COVID-19) have high in-hospital mortality. The information on outcome of cirrhosis patients in post-hospitalization period are limited.
Aims: We aimed to study the outcome of cirrhosis patients with COVID-19 after hospital discharge.
Methods: The records of the cirrhosis patients discharged after COVID-19 were reviewed. Their data were compared with a similar number of cirrhosis patients without COVID-19 after propensity score matching for age, sex, etiology of cirrhosis, and model for end-stage liver disease (MELD) score.
Results: Cirrhosis patients with (n=92) or without (n=92) COVID-19 were included in 1:1 ratio. The mortality among COVID-19 (22; 23.9%) and non-COVID-19 (19; 20.7%) were comparable (HR 1.224; 95% CI 0.663-2.263, P=0.520), over a similar duration of follow-up [186 (86-271) vs 183 (103-274)]. Among COVID-19 patients, 45; 48.9% developed a new acute decompensation-increased ascites (40; 43.5%), hepatic encephalopathy (20; 21.7%), or variceal bleeding (8; 8.7%) whereas 25 (27.2%) patients needed re-hospitalization. A proportion of participants continued to have either fatigue/weakness (24/80; 30.0%), sleep disturbances (11/80; 13.7%), or joint pains (16/80; 20.0%). The most common causes of death in patients of both groups were end-stage liver disease: 16 (72.7%) vs 9 (47.4%), followed by multiorgan dysfunction: 4 (18.2%) vs 6 (31.6%), GI bleeding: 2 (9.1%) vs. 4 (21.0%), P=0.484. A lower albumin level, higher international normalized ratio, bilirubin, Child-Turcotte-Pugh, and MELD scores at discharge predicted mortality in the COVID-19 group.
Conclusion: Short-term outcomes of patients with cirrhosis who survive the initial insult of COVID-19 are not different from patients without COVID-19, and survival is determined by the severity of liver disease at discharge.
Keywords: ACE2, Angiotensin-converting enzyme 2; AD, acute decompensation; AIH, autoimmune hepatitis; ALT, alanine aminotransferase; AST, aspartate aminotransferase; Alk P, alkaline phosphatase; COVID-19, coronavirus disease-2019; CTP, Child-Turcotte-Pugh; GI, Gastrointestinal; HBV, hepatitis B virus; HCV, hepatitis C virus; INR, international normalized ratio; IQR, interquartile range; MELD, model for end-stage liver disease; NAFLD, non-alcoholic fatty liver disease; TLC, Total leukocyte count; chronic liver disease; coronavirus; mortality; pandemic; virus.
. 2021 Nov 24.
doi: 10.1016/j.jceh.2021.11.009. Online ahead of print.
The Outcome after Hospital Discharge in Cirrhosis is Not Worsened with COVID-19 Infection: A Propensity Score-matched Analysis
Manas Vaishnav[SUP] 1 [/SUP], Anshuman Elhence[SUP] 1 [/SUP], Sagnik Biswas[SUP] 1 [/SUP], Piysuh Pathak[SUP] 1 [/SUP], Abhinav Anand[SUP] 1 [/SUP], Sabreena Sheikh[SUP] 1 [/SUP], Vishwajeet Singh[SUP] 2 [/SUP], Souvik Maitra[SUP] 3 [/SUP], Amit Goel[SUP] 4 [/SUP], Shalimar[SUP] 1 [/SUP]
Affiliations
- PMID: 34840484
- PMCID: PMC8610830
- DOI: 10.1016/j.jceh.2021.11.009
Abstract
Background: Patients with cirrhosis and coronavirus disease-2019 (COVID-19) have high in-hospital mortality. The information on outcome of cirrhosis patients in post-hospitalization period are limited.
Aims: We aimed to study the outcome of cirrhosis patients with COVID-19 after hospital discharge.
Methods: The records of the cirrhosis patients discharged after COVID-19 were reviewed. Their data were compared with a similar number of cirrhosis patients without COVID-19 after propensity score matching for age, sex, etiology of cirrhosis, and model for end-stage liver disease (MELD) score.
Results: Cirrhosis patients with (n=92) or without (n=92) COVID-19 were included in 1:1 ratio. The mortality among COVID-19 (22; 23.9%) and non-COVID-19 (19; 20.7%) were comparable (HR 1.224; 95% CI 0.663-2.263, P=0.520), over a similar duration of follow-up [186 (86-271) vs 183 (103-274)]. Among COVID-19 patients, 45; 48.9% developed a new acute decompensation-increased ascites (40; 43.5%), hepatic encephalopathy (20; 21.7%), or variceal bleeding (8; 8.7%) whereas 25 (27.2%) patients needed re-hospitalization. A proportion of participants continued to have either fatigue/weakness (24/80; 30.0%), sleep disturbances (11/80; 13.7%), or joint pains (16/80; 20.0%). The most common causes of death in patients of both groups were end-stage liver disease: 16 (72.7%) vs 9 (47.4%), followed by multiorgan dysfunction: 4 (18.2%) vs 6 (31.6%), GI bleeding: 2 (9.1%) vs. 4 (21.0%), P=0.484. A lower albumin level, higher international normalized ratio, bilirubin, Child-Turcotte-Pugh, and MELD scores at discharge predicted mortality in the COVID-19 group.
Conclusion: Short-term outcomes of patients with cirrhosis who survive the initial insult of COVID-19 are not different from patients without COVID-19, and survival is determined by the severity of liver disease at discharge.
Keywords: ACE2, Angiotensin-converting enzyme 2; AD, acute decompensation; AIH, autoimmune hepatitis; ALT, alanine aminotransferase; AST, aspartate aminotransferase; Alk P, alkaline phosphatase; COVID-19, coronavirus disease-2019; CTP, Child-Turcotte-Pugh; GI, Gastrointestinal; HBV, hepatitis B virus; HCV, hepatitis C virus; INR, international normalized ratio; IQR, interquartile range; MELD, model for end-stage liver disease; NAFLD, non-alcoholic fatty liver disease; TLC, Total leukocyte count; chronic liver disease; coronavirus; mortality; pandemic; virus.