tetano
Editor, Senior Moderator
JGH Open
. 2025 Mar 24;9(3):e70142.
doi: 10.1002/jgh3.70142. eCollection 2025 Mar. Post COVID Condition and Long-Term COVID-19 Impact on Hepatic Decompensation and Survival in Cirrhosis: A Propensity Matched Observational Study
Prerna Sharma[SUP] 1 [/SUP], Madhumita Premkumar[SUP] 1 [/SUP], Rashmi Ranjan Guru[SUP] 2 [/SUP], Anchal Sandhu[SUP] 1 [/SUP], Kamal Kajal[SUP] 3 [/SUP], Arka De[SUP] 1 [/SUP], Sahaj Rathi[SUP] 1 [/SUP], Nipun Verma[SUP] 1 [/SUP], Sunil Taneja[SUP] 1 [/SUP], Virendra Singh[SUP] 1 [/SUP], Ajay Kumar Duseja[SUP] 1 [/SUP]
Affiliations
Aims: Patients with cirrhosis are susceptible to decompensation events, including ascites, variceal bleeding (VB), hepatic encephalopathy, or death after COVID-19 infection. Patients may experience post-COVID condition (PCC) with multisystem involvement that persists for at least 2 months.
Methods: Hospitalized patients with cirrhosis and COVID-19 between January 2021 and January 2023 were assessed for decompensation events and mortality and compared to a propensity-matched cohort of cirrhosis and non-COVID-19 sepsis. Both groups were followed for outcomes over 1 year.
Results: Of 252 patients with Cirrhosis+ COVID-19 (73% men, aged 48.9 ± 13.7 years, 31%-diabetes, 44%-hypertension, 35%-alcohol-associated, 34.5%-metabolic dysfunction-associated steatotic liver disease; MASLD), 72 (28.6%) died in hospital and 180 (71.4%) recovered, similar to Cirrhosis+ non-COVID-sepsis (58/214, 27.1%). Finally,60 (33.3%) met criteria for PCC, 19 (10.5%) had no post COVID-19 sequelae and 101 (56.1%) patients died (N = 45) or were lost to follow up (N = 56). Late Mortality was higher in Cirrhosis+ COVID-19 than non-COVID-sepsis (56.1% vs. 35.3%, p = 0.026). Patients with PCC were aged 47.6 years, 63.3%-men, Charlson Comorbidity Index > 4 (51.7%), 45%-diabetes, 56.7%-hypertension, with 33.3%, 23.3%, and 43.3% in Child-Turcotte-Pugh class A, B and C, respectively. PCC symptoms included persistent dyspnea (34, 43%), cognitive impairment (20, 25.3%), and anxiety (47, 59.4%). On multivariable analysis, predictors of the development of PCC were baseline MELDNa (HR 1.12, 95% CI: 1.05-1.17, p < 0.001) and age (HR 0.9, 95% CI: 0.91-0.99, p = 0.012). Predictors of mortality following COVID-19 recovery were MELDNa (HR 1.03, 95% CI: 1.01-1.05, p = 0.008), age (HR 1.2, 95% CI: 1.1-1.5, p = 0.002) and hypertension (HR 1.63, 95% CI: 1.07-2.49, p = 0.025).
Conclusion: COVID-19 is associated with long-term mortality in cirrhosis even after recovery from respiratory infection. Long COVID is seen in a third of COVID-19 survivors in patients with cirrhosis.
Keywords: COVID‐19 liver failure; SARS‐CoV‐2; acute decompensation of cirrhosis; cirrhosis; coronavirus; long COVID‐19; portal hypertension; post COVID condition; viral pneumonia.
. 2025 Mar 24;9(3):e70142.
doi: 10.1002/jgh3.70142. eCollection 2025 Mar. Post COVID Condition and Long-Term COVID-19 Impact on Hepatic Decompensation and Survival in Cirrhosis: A Propensity Matched Observational Study
Prerna Sharma[SUP] 1 [/SUP], Madhumita Premkumar[SUP] 1 [/SUP], Rashmi Ranjan Guru[SUP] 2 [/SUP], Anchal Sandhu[SUP] 1 [/SUP], Kamal Kajal[SUP] 3 [/SUP], Arka De[SUP] 1 [/SUP], Sahaj Rathi[SUP] 1 [/SUP], Nipun Verma[SUP] 1 [/SUP], Sunil Taneja[SUP] 1 [/SUP], Virendra Singh[SUP] 1 [/SUP], Ajay Kumar Duseja[SUP] 1 [/SUP]
Affiliations
- PMID: 40135045
- PMCID: PMC11932954
- DOI: 10.1002/jgh3.70142
Aims: Patients with cirrhosis are susceptible to decompensation events, including ascites, variceal bleeding (VB), hepatic encephalopathy, or death after COVID-19 infection. Patients may experience post-COVID condition (PCC) with multisystem involvement that persists for at least 2 months.
Methods: Hospitalized patients with cirrhosis and COVID-19 between January 2021 and January 2023 were assessed for decompensation events and mortality and compared to a propensity-matched cohort of cirrhosis and non-COVID-19 sepsis. Both groups were followed for outcomes over 1 year.
Results: Of 252 patients with Cirrhosis+ COVID-19 (73% men, aged 48.9 ± 13.7 years, 31%-diabetes, 44%-hypertension, 35%-alcohol-associated, 34.5%-metabolic dysfunction-associated steatotic liver disease; MASLD), 72 (28.6%) died in hospital and 180 (71.4%) recovered, similar to Cirrhosis+ non-COVID-sepsis (58/214, 27.1%). Finally,60 (33.3%) met criteria for PCC, 19 (10.5%) had no post COVID-19 sequelae and 101 (56.1%) patients died (N = 45) or were lost to follow up (N = 56). Late Mortality was higher in Cirrhosis+ COVID-19 than non-COVID-sepsis (56.1% vs. 35.3%, p = 0.026). Patients with PCC were aged 47.6 years, 63.3%-men, Charlson Comorbidity Index > 4 (51.7%), 45%-diabetes, 56.7%-hypertension, with 33.3%, 23.3%, and 43.3% in Child-Turcotte-Pugh class A, B and C, respectively. PCC symptoms included persistent dyspnea (34, 43%), cognitive impairment (20, 25.3%), and anxiety (47, 59.4%). On multivariable analysis, predictors of the development of PCC were baseline MELDNa (HR 1.12, 95% CI: 1.05-1.17, p < 0.001) and age (HR 0.9, 95% CI: 0.91-0.99, p = 0.012). Predictors of mortality following COVID-19 recovery were MELDNa (HR 1.03, 95% CI: 1.01-1.05, p = 0.008), age (HR 1.2, 95% CI: 1.1-1.5, p = 0.002) and hypertension (HR 1.63, 95% CI: 1.07-2.49, p = 0.025).
Conclusion: COVID-19 is associated with long-term mortality in cirrhosis even after recovery from respiratory infection. Long COVID is seen in a third of COVID-19 survivors in patients with cirrhosis.
Keywords: COVID‐19 liver failure; SARS‐CoV‐2; acute decompensation of cirrhosis; cirrhosis; coronavirus; long COVID‐19; portal hypertension; post COVID condition; viral pneumonia.