The impact of COVID-19 on the clinical course and outcome of patients with cirrhosis: An observational study

Background and AimsSevere outcomes of COVID-19 are associated with advancing age and comorbidities. The specific aim of our study was to determine the impact of COVID-19 on the clinical course and outcome of patients with cirrhosis.MethodsWe retrieved data from VA national repository and identified patients tested for SARS-CoV-2 RNA who had cirrhosis. Each virus positive patient was propensity-matched with virus negative subjects by demographics and comorbidities. Primary endpoint was death within 30 days of COVID-19 diagnosis and secondary endpoint was hospitalization within 14 days.ResultsAmong 1,115,037 individuals tested for SARS-CoV-2 RNA, 31,680 had cirrhosis. Of those patients, 4456 virus positive patients were propensity-matched with 8752 virus negative subjects. In this cohort of 13,208, median age was 67 years and 95% were male. Most had multiple comorbidities. Alcohol use, hepatitis C and MASH were the dominant etiologies of cirrhosis. At baseline, median MELD was 6% and 21% had hepatic decompensation. Advanced age was the most significant determinant of hospitalization and mortality. Comorbidities, alcohol use and MELD increased the likelihood of hospitalization whereas SARS-CoV-2 positivity had lower Day-14 hospitalization hazard. MELD was associated with higher mortality hazard whereas vaccination reduced the hazard of hospitalization and death. SARS-CoV-2 positivity increased the hazard of death at Day-30 by 72% and at Day-90 by 26%.ConclusionAlthough patients with cirrhosis who developed COVID-19 were less likely to be hospitalized, they were more likely to die within 30 days compared to their virus negative counterparts. Vaccination was effective in reducing both hospitalization and death. Patients with cirrhosis who develop COVID-19, in particular aged 65 years or older, are at increased risk of death which may be prevented by vaccination. BACKGROUND: Using data from Veterans Affairs national repository, we identified patients with cirrhosis who were tested for SARS-CoV-2, to determine the impact of COVID-19 on the outcome of such patients. FINDINGS: In the study cohort of 13,208 patients with 4456 SARS-CoV-2 positive patients propensity matched to virus negative subjects, SARS-CoV-2 infection was associated with 9% lower hazard of 14-day hospitalization but 72% increased hazard of 30-day mortality. IMPLICATIONS FOR PATIENT CARE: The study confirmed prior observations that COVID-19 increased the mortality risk of patients with cirrhosis. It also validated the effectiveness of vaccination in reducing both hospitalization and death among patients with cirrhosis.