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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 30 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 Hepatology.
The COVID-Hep.net registry and COVIDCirrhosis.org registry accumulated 152 consecutive physician reports of laboratory-confirmed cases of COVID-19 between 25 March and 20 April 2020, of cases with definite outcomes (either death or discharge from hospital). The registry is an uncontrolled study of cases voluntarily reported by doctors and the findings highlight trends rather than prospective analysis of all patients treated at a range of clinical centres.
One hundred and three 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.
Ninety-five per cent 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 without cirrhosis.
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-CoV-2 in any patient with chronic liver disease who experiences a decompensation event.
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