Cirrhosis and SARS‐CoV‐2 infection in US Veterans: risk of infection, hospitalization, ventilation and mortality.

Ioannou, George N.; Liang, Peter S.; Locke, Emily; Green, Pamela; Berry, Kristin; O’Hare, Ann M.; Shah, Javeed A.; Crothers, Kristina; Eastment, McKenna C.; Fan, Vincent S; Dominitz, Jason A.

BACKGROUND AND AIMS: Whether patients with cirrhosis have increased risk of SARS‐CoV‐2 infection and the extent to which infection and cirrhosis increase the risk of adverse patient outcomes remain unclear. APPROACH AND RESULTS: We identified 88,747 patients tested for SARS‐CoV‐2 between 3/1/20‐5/14/20 in the Veterans Affairs (VA) national healthcare system, including 75,315 with no cirrhosis‐SARS‐CoV‐2 negative (C0‐S0), 9826 with no cirrhosis‐SARS‐CoV‐2 positive (C0‐S1); 3301 with cirrhosis‐SARS‐CoV‐2 negative (C1‐S0); and 305 with cirrhosis‐SARS‐CoV‐2 positive (C1‐S1). Patients were followed through 6/22/20. Hospitalization, mechanical ventilation and death were modeled in time‐to‐event analyses using Cox proportional hazards regression. Patients with cirrhosis were less likely to test positive than patients without cirrhosis (8.5% vs. 11.5%, adjusted odds ratio 0.83, 95% CI 0.69‐0.99). Thirty‐day mortality and ventilation rates increased progressively from C0‐S0 (2.3% and 1.6%), to C1‐S0 (5.2% and 3.6%), to C0‐S1 (10.6% and 6.5%), to C1‐S1(17.1% and 13.0%). Among patients with cirrhosis, those who tested positive for SARS‐CoV‐2 were 4.1 times more likely to undergo mechanical ventilation (adjusted hazard ratio [aHR] 4.12, 95% CI 2.79‐6.10) and 3.5 times more likely to die (aHR 3.54, 95% CI 2.55‐4.90) than those who tested negative. Among patients with SARS‐CoV‐2 infection, those with cirrhosis were more likely to be hospitalized (aHR 1.37, 95% CI 1.12‐1.66), undergo ventilation (aHR 1.61, 95% CI 1.05‐2.46) or die (aHR 1.65, 95% CI 1.18‐2.30) than patients without cirrhosis. Among patients with cirrhosis and SARS‐CoV‐2 infection, the most important predictors of mortality were advanced age, cirrhosis decompensation and high MELD score. CONCLUSIONS: SARS‐CoV‐2 infection was associated with a 3.5‐fold increase in mortality in patients with cirrhosis. Cirrhosis was associated with a 1.7‐fold increase in mortality in patients with SARS‐CoV‐2 infection.