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Abstract Details
Predictors of Outcomes of COVID-19 in Patients With Chronic Liver Disease: US Multi-center Study
Donghee Kim1, Nia Adeniji1, Nyann Latt2, Sonal Kumar3, Patricia P Bloom4, Elizabeth S Aby5, Ponni Perumalswami6, Marina Roytman7, Michael Li8, Alexander S Vogel8, Andreea M Catana9, Kara Wegermann10, Rotonya M Carr11, Costica Aloman12, Vincent L Chen13, Atoosa Rabiee14, Brett Sadowski15, Veronica Nguyen16, Winston Dunn17, Kenneth D Chavin18, Kali Zhou19, Blanca Lizaola-Mayo20, Akshata Moghe21, José Debes5, Tzu-Hao Lee10, Andrea D Branch6, Kathleen Viveiros8, Walter Chan8, David M Chascsa20, Paul Kwo1, Renumathy Dhanasekaran22
Author information
1Stanford University, Stanford, California.
2Ochsner Medical Center, New Orleans, Louisiana.
3Weill Cornell Medicine, New York, New York.
4Massachusetts General Hospital, Boston, Massachusetts.
5Hennepin County Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota.
6Icahn School of Medicine at Mount Sinai, New York, New York.
7University of California San Francisco, Fresno, California.
8Brigham and Women's Hospital, Boston, Massachusetts.
9Beth Israel Deaconess Medical Center, Boston, Massachusetts.
10Duke University, Durham, North Carolina.
11University of Pennsylvania, Philadelphia, Pennsylvania.
12Rush University Medical Center, Chicago, Illinois.
13University of Michigan, Ann Arbor, Michigan.
14VA Medical Center, Washington, District of Columbia.
15Georgetown University, Washington, District of Columbia.
16University of Arizona/BannerHealth, Tucson, Arizona.
17University of Kansas Medical Center, Kansas City, Kansas.
18University Hospitals Cleveland Medical Center, Cleveland, Ohio.
19University of Southern California, Los Angeles, California.
20Mayo Clinic, Scottsdale, Arizona.
21University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
22Stanford University, Stanford, California.
Abstract
Background & aims: Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19).
Methods: We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD.
Results: Of the 978 patients in our cohort, 867 patients (mean age 56.9 ± 14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19.
Conclusions: The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19. Clinicaltrials.gov number NCT04439084.