COVID-19 News: Studies Warn That Individuals With Liver Cirrhosis Likely To Die Upon Contracting COVID-19
: Studies are indicating that individuals with existing chronic liver conditions especially severe cirrhosis are at a great risk of dying upon contracting the COVID-19 Disease.
Just 3 studies alone published in the Journal of Hepatology supports this conclusion with numerous other similar studies appearing in various other journals as well.
Individuals with chronic liver disease admitted to hospital with COVID-19 are dying at a much higher rate than the rest of the population, figures collated by liver specialists in Europe, Asia and North America show.
All the studies indicated that advanced cirrhosis greatly increased the risk of death.
Individuals with severe cirrhosis were almost 30 times more likely to die after a COVID-19 diagnosis than people with chronic liver disease without cirrhosis, the figures show. The overall death rate in people with chronic liver disease was 39% among reported cases.
It was reported that two international registries that were established in March 2020 to track the outcomes of people with chronic liver disease and cirrhosis after diagnosis with COVID-19 are showing the same conclusions.
Medical investigators from 14 specialist liver clinics in the United States, Spain and the United Kingdom have reported on the first 152 cases submitted to the registries, in a publication in the Journal of Hepatology
So far large case series published have not shown a high prevalence of chronic liver disease in individuals hospitalized with COVID-19, suggesting that individuals with chronic liver conditions are not at higher risk of developing severe symptoms because of SARS-CoV-2 infection.
To date however, no study has looked specifically at the clinical outcomes of people known to have chronic liver disease.
Both the COVID-Hep.net registry and COVIDCirrhosis.org registry accumulated 152 consecutive physician reports of laboratory-confirmed cases of COVID-19 between 25 March and 20 April 2020, of cases with definite outcomes (either death or discharge from hospital).
A total of one hundred and three were cases of cirrhosis. 22.3% of reported cases occurred in people with viral hepatitis, 22.4% in people with non-alcoholic fatty liver disease and 19.7% in alcoholic liver disease. The remainder had other causes or a combination of causes.
The typical median age of reported cases was 61 years and 59% were male. Twenty-one per cent were obese (BMI > 30 kg/m2), 21% had cardio
vascular disease, 35% diabetes and 39% hypertension.
Of the ninety-five per cent of the reported cases were admitted to hospital, and 23% were admitted to an intensive care unit. Forty-seven of the 152 people died (39.8%).
Detailed multivariable analysis showed that severe cirrhosis (Child-Pugh C stage) was strongly associated with an increased risk of death from COVID-19. People in Child-Pugh stage C, who comprised 17.8% of all reported cases, were 28 times more likely to die than people without cirrhosis (32.2% of cases) (odds ratio 28.07, 95% CI 4.42-178.46, p < 0.001). Sixty-three per cent of people with Child-Pugh stage C cirrhosis died compared to 12.2% of those without cirrhosis.
Individuals with Child-Pugh stage B cirrhosis also had a higher risk of death (OR 4.90, 95% CI 1.16-20.61, p = 0.030).
Interestingly obesity was the other significant risk factor; obese people were approximately three-and-a half times more likely to die (OR 3.59, 95% CI 1.1-10.47, p = 0.033). Older age had a borderline significant impact on the risk of dying, but other underlying conditions did not emerge as significant risk factors after controlling for other risk factors including cirrhosis stage.
Significantly decompensation events (worsening ascites, variceal haemorrhage, hepatic encephalopathy or bacterial peritonitis) occurred significantly more often in those who died (51% vs 14%, p < 0.001) and 12.2% of deaths were classified as liver-related.
Decompensation events occurred frequently in the reported cases; around half of people with Child-Pugh B or C cirrhosis suffered at least one new or worsening event after diagnosis with COVID-19 and these events often occurred in people without respiratory symptoms of COVID-19.
The researchers say that the study findings regarding decompensation events, especially in the absence of respiratory symptoms, underline the importance of testing for SARS-CoV-2 in any patient with chronic liver disease who experiences a decompensation event.
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