High rates of 30-day mortality in patients with cirrhosis and COVID-19

Iavarone, Massimo; D’Ambrosio, Roberta; Soria, Alessandro; Triolo, Michela; Pugliese, Nicola; Del Poggio, Paolo; Perricone, Giovanni; Massironi, Sara; Spinetti, Angiola; Buscarini, Elisabetta; Viganò, Mauro; Carriero, Canio; Fagiuoli, Stefano; Aghemo, Alessio; Belli, Luca S.; Lucà , Martina; Pedaci, Marianna; Rimondi, Alessandro; Rumi, Maria Grazia; Invernizzi, Pietro; Bonfanti, Paolo; Lampertico, Pietro

BACKGROUND AND AIMS: Coronavirus disease (COVID-19) is a major worldwide threat for healthy individuals as well as for patients with comorbidities, but its impact on patients with cirrhosis is currently unknown. This study aimed at evaluating the impact of COVID-19 on the clinical outcome of these patients. METHODS: In this multicenter retrospective study, cirrhotic patients with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection were enrolled between 1(st) and 31(th) March 2020. Clinical and biochemical data at COVID-19 and at the last outpatient visit were obtained through review of medical records. RESULTS: Fifty cirrhotic patients with confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or prolonged an ongoing one. Respiratory-support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with MELD≥15 increased from 13% to 26% (p=0.037), acute-on-chronic liver failure and and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. Severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. Mortality was significantly higher in hospitalized cirrhotics with COVID-19 than in those hospitalized for bacterial infections. CONCLUSION: COVID-19 is associated with liver function deterioration and elevated mortality in cirrhotic patients.