High rates of 30-day mortality in patients with cirrhosis and COVID-19

Massimo Iavarone, Roberta D'Ambrosio, Alessandro Soria, Michela Triolo, Nicola Pugliese, Paolo Del Poggio, Giovanni Perricone, Sara Massironi, Angiola Spinetti, Elisabetta Buscarini, Mauro Viganò, Canio Carriero, Stefano Fagiuoli, Alessio Aghemo, Luca S. Belli, Martina Lucà, Marianna Pedaci, Alessandro Rimondi, Maria Grazia Rumi, Pietro InvernizziPaolo Bonfanti, Pietro Lampertico

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. Methods: In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. Results: Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4–13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. Conclusion: COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. Lay summary: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.
Original languageEnglish
Pages (from-to)1063-1071
Number of pages9
JournalJ. Hepatol.
Volume73
Issue number5
DOIs
Publication statusPublished - 2020

Keywords

  • HBV
  • HCV
  • Hepatitis
  • Hepatocellular carcinoma
  • Liver transplantation
  • SARS-CoV-2

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