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Mortality in Patients with Cirrhosis and COVID-19

Mortality in Patients with Cirrhosis and COVID-19

To evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis in a multi-center, retrospective study, patients with cirrhosis and the confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 3/1/2020 and 3/31/2020. Clinical and biochemical data and diagnosis of COVID-19 at the last outpatient visit were obtained through review of medical records.

A total of 50 patients with cirrhosis and with confirmed SARS-CoV-2 infection were enrolled (age 67, 70% men, 38% virus-related, 52% previously compensated cirrhosis), 64% of patients presented fever, 42% shortness of breath, polypnea, 22% encephalopathy, 96% either hospitalization or a prolonged stay if already in hospital. 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 a MELD score greater than 15 increased from 13% to 26%, acuteon-chronic liver failure and de novo acute liver injury occurred in 14 (28%), and 10 patients, respectively. A total of 17 patients died after a median of 10 days from COVID-19 diagnosis with a 30-day mortality rate of 34%. The severity of lung and liver disease has independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections.

It was concluded that COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis.

Lavarone, M., D’Ambrosio, R., Soria, A., et al. “High Rates of 30-Day Mortality in Patients with Cirrhosis and COVID-19.” Journal of Hepatology 2020; Vol. 73, pp. 1063-1071.

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