Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study

Galiero, Raffaele; Pafundi, Pia Clara; Simeon, Vittorio; Rinaldi, Luca; Perrella, Alessandro; Vetrano, Erica; Caturano, Alfredo; Alfano, Maria; Beccia, Domenico; Nevola, Riccardo; Marfella, Raffaele; Sardu, Celestino; Coppola, Carmine; Scarano, Ferdinando; Maggi, Paolo; De Lucia Sposito, Pellegrino; Vocciante, Laura; Rescigno, Carolina; Sbreglia, Costanza; Fraganza, Fiorentino; Parrella, Roberto; Romano, Annamaria; Calabria, Giosuele; Polverino, Benedetto; Pagano, Antonio; Bologna, Carolina; Amitrano, Maria; Esposito, Vincenzo; Coppola, Nicola; Maturo, Nicola; Adinolfi, Luigi Elio; Chiodini, Paolo; Sasso, Ferdinando Carlo

BACKGROUND: Italy has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory. OBJECTIVES: Aim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy). METHODS: COVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission. RESULTS: Among 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42–4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39–14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21–5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings. CONCLUSION: Mortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage.