Pre-Existing Cirrhosis Linked to Higher COVID-19 Mortality

A team of investigators in Italy assessed outcomes in patients with both cirrhosis and COVID-19 infection.

Infection with coronavirus disease 2019 (COVID-19) was associated with declining liver function, and patients with pre-existing cirrhosis were found to have higher mortality rates than patients without cirrhosis, according to a multicenter retrospective study published in the Journal of Hepatology.

During March 2020, a team of investigators recruited 50 patients with cirrhosis who were being cared for at 9 hospitals in Lombardy, Italy, and in whom COVID-19 infection was confirmed by nasopharyngeal swab testing. For comparison to the general population, mortality rates from the same time period for patients infected with COVID-19 were retrospectively collected from Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico.

The patient population had an average age of 67 years, 70% were men, 52% had previously compensated cirrhosis, and 38% had virus-related cirrhosis. Upon COVID-19 diagnosis, 96% required hospitalization and 64% presented with fever, 42% with shortness of breath, and 22% with encephalopathy. Heparin (80%), respiratory support (71%), and antivirals (52%) were administered.

After infection, creatinine, aspartate aminotransferase, bilirubin, and international normalized ratio (INR) levels were found to be significantly increased, while albumin levels were significantly decreased (P =.007, P =.024, P =.026, P =.042, P =.0003, respectively). The proportion of patients with a Model for End-Stage Liver Disease (MELD) score of 15 or greater increased significantly after a COVID-19 diagnosis (13% vs 26%; P =.037).

After a median of 10 days (range, 4-13 days), 17 patients died from COVID-19 complications; the 30-day mortality rate was reported as 34%. In multivariate analysis, independent predictors of mortality were MELD score (hazard ratio [HR], 1.094; 95% CI, 1.047-1.144; P ≤.0001), European Foundation for the Study of Chronic Liver Failure (CLIF-C) organ failure scores (HR, 1.426; 95% CI, 1.122-1.668; P ≤.0001), moderate to severe lung failure (HR, 1.950; 95% CI, 1.279-2.974; P =.002), and CLIF-C scores (HR, 1.097; 95% CI, 1.001-1.133; P =.047).

Mortality was lower in patients without cirrhosis and COVID-19 compared with those with cirrhosis and COVID-19 (18% vs 34%; P =.035).

Limitations of this study included the short duration, small sample size, and retrospective design. However, the investigators had to navigate the logistical constraints of performing a scientific study during a pandemic.

The study authors concluded that COVID-19 infection was associated with liver function deterioration, and that patients with pre-existing liver conditions had a higher coronavirus mortality rate then the general population.

Disclosures: Some authors declared receiving consulting funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.

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Iavarone M, D’Ambrosio R, Soria A, et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19 [published online June 8, 2020]. J Hepatol. doi:10.1016/j.jhep.2020.06.001.