Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study

Marjot, Thomas; Moon, Andrew M.; Cook, Jonathan A.; Abd-Elsalam, Sherief; Aloman, Costica; Armstrong, Matthew J.; Pose, Elisa; Brenner, Erica J.; Cargill, Tamsin; Catana, Maria-Andreea; Dhanasekaran, Renumathy; Eshraghian, Ahad; García-Juárez, Ignacio; Gill, Upkar S.; Jones, Patricia D.; Kennedy, James; Marshall, Aileen; Matthews, Charmaine; Mells, George; Mercer, Carolyn; Perumalswami, Ponni V.; Avitabile, Emma; Qi, Xialong; Su, Feng; Ufere, Nneka N.; Wong, Yu Jun; Zheng, Ming-Hua; Barnes, Eleanor; Barritt, Alfred S.; Webb, Gwilym J.

BACKGROUND: Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation leading to concerns that these patients may be at risk of adverse outcomes following SARS-CoV-2 infection. However, the impact of COVID-19 among patients with pre-existing liver disease remains ill-defined. METHODS: Data for CLD patients with SARS-CoV-2 were collected by two international registries. Comparisons were made with non-CLD patients with SARS-CoV-2 from a UK hospital network. RESULTS: Between 25th March and 8th July 2020, 745 CLD patients were reported from 29 countries including 386 with cirrhosis and 359 without. Mortality was 32% in patients with cirrhosis compared with 8% in those without (p<0.001). Mortality in cirrhosis patients increased according to Child-Turcotte-Pugh class (CTP-A (19%), CTP-B (35%), CTP-C (51%)) and the main cause of death was respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (OR 1.02; 1.01–1.04), CTP-A (OR 1.90; 1.03–3.52), CTP-B (OR 4.14; 2.4–7.65), CTP-C cirrhosis (OR 9.32; 4.80–18.08) and alcohol related liver disease (ALD) (OR 1.79; 1.03–3.13). When comparing CLD versus non-CLD (n=620) in propensity-score-matched analysis there were significant increases in mortality with CTP-B +20.0% (8.8%–31.3%) and CTP-C cirrhosis +38.1% (27.1%–49.2%). Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of which 21% had no respiratory symptoms. 50% of those with hepatic decompensation had acute-on-chronic liver failure. CONCLUSIONS: This is the largest reported cohort of CLD and cirrhosis patients with SARS-CoV-2 infection to date. We demonstrate that baseline liver disease stage and ALD are independent risk factor for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic.