SARS-CoV-2 Outcomes in Patients With Chronic Liver Disease

diseased liver
diseased liver, cirrhosis, liver cirrhosis
Investigators assessed the outcomes of SARS-CoV-2 positivity in patients with chronic liver diseases and cirrhosis.

Patients with chronic liver diseases (CLD) and cirrhosis, who tested positive for SARS-CoV-2 infection, had higher mortality than patients with CLD and cirrhosis without SARS-CoV-2 infection, according to the results of a study published in Gastroenterology.

Investigators utilized the National COVID Cohort Collaborative, a centralized source of electronic health record data, to analyze the outcomes of SARS-CoV-2 infection in patients with CLD, with or without cirrhosis. Approximately 221,000 patients with CLD, from 57 clinical sites across the United States, were included in the study. Patients were divided into 4 categories: non-cirrhosis/SARS-CoV-2 negative, non-cirrhosis/SARS-CoV-2 positive, cirrhosis/SARS-CoV-2 negative, and cirrhosis/SARS-CoV-2 positive.

The primary outcome of the study was all-cause mortality at 30-days after SARS-CoV-2 testing. Secondary outcomes included all-cause mortality at 90-days, hospitalization within 30- and 90-days, and mechanical ventilation within 30- and 90-days of the SARS-CoV-2 test date.

After adjusting for multiple confounding factors including race/ethnicity and source of CLD, SARS-CoV-2 positivity in patients with cirrhosis was correlated with 2.38-times hazard of death within 30 days (adjusted hazard ratio [aHR], 2.38; 95% CI, 2.18-2.59; P <.01) compared with cirrhosis/SARS-CoV-2 negative patients. When compared with non-cirrhosis/SARS-CoV-2 positive patients, cirrhosis/SARS-CoV-2 positive patients had a 3.31-times hazard of death within 30 days (aHR, 3.31; 95% CI, 2.91-3.77; P <.01).

The limitations of this study mirror the limitations of the data source; namely, a dependence on larger academic institutions as sources of clinical sites and certain states having more robust representation than others. Differences in terminology from data sources may also have impacted the results.

According to investigators, these results emphasize the importance of vaccination in the CLD patient population.


Ge J, Pletcher MJ, Lai JC, for the N3C Consortium. Outcomes of SARS-CoV-2 infection in patients with chronic liver disease and cirrhosis: a national COVID cohort collaborative study. Gastroenterol. Published online July 18, 2021. doi: 10.1053/j.gastro.2021.07.010