People with chronic liver disease admitted to hospital with
COVID-19 are dying at a much higher rate than the rest of the population,
figures collated by liver specialists in Europe, Asia and North America show. Advanced cirrhosis greatly increased the risk of death, the study found.
People with severe cirrhosis were almost thirty times more
likely to die after a COVID-19 diagnosis than people with chronic liver disease
without cirrhosis, the figures show. The overall death rate in people with chronic liver disease was 39% among reported cases.
Two international registries were established in March 2020
to track the outcomes of people with chronic liver disease and cirrhosis after
diagnosis with COVID-19. Investigators from 14 specialist liver clinics in the
United States, Spain and the United Kingdom have now reported on the first 152
cases submitted to the registries, in a publication in the Journal of
An accumulation of fluid in the abdomen; may be caused by liver damage, especially cirrhosis.
A disease or infection affecting the brain.
Large case series published to date have not shown a high
prevalence of chronic liver disease in people hospitalised with COVID-19, suggesting
that people with chronic liver conditions are not at higher risk of developing
severe symptoms because of SARS-CoV2 infection.
However, no study has looked specifically at the clinical
outcomes of people known to have chronic liver disease.
The COVID-Hep.net registry and COVIDCirrhosis.org registry
accumulated 152 consecutive physician reports of laboratory-confirmed cases of
COVID-19 between 25 March 2020 and 20 April 2020, of cases with definite
outcomes (either death or discharge from hospital).
103 were cases of cirrhosis. 22.3% of reported cases occurred
in people with viral hepatitis, 22.4% in people with non-alcoholic fatty liver
disease and 19.7% in alcoholic liver disease. The remainder had other causes or
a combination of causes.
The median age of reported cases was 61 years and 59% were
male. 21% were obese (BMI > 30 kg/m2), 21% had cardiovascular disease, 35%
diabetes and 39% hypertension.
Ninety-five percent of the reported cases were admitted to
hospital, and 23% were admitted to an intensive care unit. Forty-seven of the
152 people died (39.8%).
Multivariable analysis showed that severe cirrhosis (Child Pugh
C stage) was strongly associated with an increased risk of death from COVID-19.
People in Child Pugh stage C, who comprised 17.8% of all reported cases, were
28 times more likely to die than people without cirrhosis (32.2% of cases)
(odds ratio 28.07, 95% CI 4.42-178.46, p<0.001). Sixty-three per cent of
people with Child Pugh stage C cirrhosis died compared to 12.2% of those
People with Child Pugh stage B cirrhosis also had a higher
risk of death (OR 4.90, 95% CI 1.16-20.61, p=0.030).
Obesity was the other significant risk factor; obese people
were approximately three-and-a half times more likely to die (OR 3.59, 95% CI
Older age had a borderline significant impact on the risk of
dying, but other underlying conditions did not emerge as significant risk
factors after controlling for other risk factors including cirrhosis stage.
Decompensation events (worsening ascites, variceal haemorrhage,
hepatic encephalopathy or bacterial peritonitis) occurred significantly more
often in those who died (51% vs 14%, p< 0.001) and 12.2% of deaths were
classified as liver-related. Decompensation events occurred frequently in the
reported cases; around half of people with Child Pugh B or C cirrhosis suffered
at least one new or worsening event after diagnosis with COVID-19 and these
events often occurred in people without respiratory symptoms of COVID-19.
The investigators say that the findings regarding
decompensation events, especially in the absence of respiratory symptoms, underline
the importance of testing for SARS-CoV2 in any patient with chronic liver disease
who experiences a decompensation event.