Predictors of Outcomes of COVID-19 in Patients with Chronic Liver Disease: US Multi-center Study

Kim, Donghee; Adeniji, Nia; Latt, Nyann; Kumar, Sonal; Bloom, Patricia P.; Aby, Elizabeth S.; Perumalswami, Ponni; Roytman, Marina; Li, Michael; Vogel, Alexander S.; Catana, Andreea M.; Wegermann, Kara; Carr, Rotonya M.; Aloman, Costica; Chen, Vincent; Rabiee, Atoosa; Sadowski, Brett; Nguyen, Veronica; Dunn, Winston; Chavin, Kenneth; Zhou, Kali; Lizaola-Mayo, Blanca; Moghe, Akshata; Debes, José; Lee, Tzu-Hao; Branch, Andrea; Viveiros, Kathleen; Chan, Walter; Chascsa, David; Kwo, Paul; Dhanasekaran, Renumathy

Background Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19). Methods We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD. Results Of the 978 patients in our cohort, 867 patients (mean age 56.9±14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19. Conclusions The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19.