INTRODUCTION: There is increasing evidence suggesting that liver dysfunction is a risk factor for severe COVID-19 illness However, due to the low prevalence of liver disease and cirrhosis in the general population, larger studies looking at the impact of these conditions have utilized data from international registries which do not necessarily reflect the US population Our study aims to assess the association between chronic liver disease and COVID-19 clinical outcomes across a single large inpatient cohort METHODS: We performed a retrospective single-center study at a large tertiary care hospital All index admissions of adult patients with confirmed COVID-19 between 3/1 and 4/20/2020 were included A manual chart review was performed to collect data on baseline patient characteristics, medical comorbidities, and clinical outcomes Patients with chronic liver disease (CLD) and cirrhosis were compared to the control group, who had no known underlying liver disease SAS 9 4 was used for analysis RESULTS: A total of 1935 patients met our inclusion criteria of which 1869 (96 6%) had no underlying liver disease, 66 (3 4%) had CLD, and 21 (1 1%) had cirrhosis Table 1 shows baseline patient characteristics There were a higher proportion of males in the CLD and cirrhosis cohorts compared to the control group (67% and 76% vs 50%;P = 0 0105) Patients with cirrhosis and chronic liver disease also had a significantly lower average BMI compared to the control group (25 8 and 27 3 vs 31 8;P50 002) There was no difference in comorbidities between all three cohorts Figure 1 shows the distribution of liver disease etiology for patients with chronic liver disease and cirrhosis In terms of outcomes, patients with cirrhosis had a significantly higher mortality (RR 2 1 [95% CI 1 33-3 62;P50 0022]) compared to non-cirrhotics (Table 2) There was also a trend towards increased 30-day readmission in the cirrhotic cohort (RR 2 35 [95% CI 0 86-6 42];P = 0 0950) however no difference in rate of ICU admission or intubation Patients with CLD did not have an increase in mortality, ICU admission, intubation, or 30-day re-admission compared to the control group CONCLUSION: Our study demonstrates that cirrhosis is associated with increased mortality in COVID-19 while chronic liver disease in the absence of cirrhosis does not confer the same degree of clinical risk Future studies performed on a larger scale should evaluate how decompensated disease and MELD score may impact this risk profile (Figure Presnted)
Impact of chronic liver disease and cirrhosis on COVID-19 patient outcomes