Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study

被引:83
作者
Ge, Jin [1 ]
Pletcher, Mark J. [2 ,3 ]
Lai, Jennifer C. [1 ]
机构
[1] Univ Calif San Francisco, Dept Med, Div Gastroenterol & Hepatol, 513 Parnassus Ave,S-357, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA
[3] Univ Calif San Francisco, Dept Med, Div Gen Internal Med, San Francisco, CA USA
关键词
COVID-19; SARS-CoV-2; Cirrhosis; OMOP; N3C; MORTALITY;
D O I
10.1053/j.gastro.2021.07.010
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: In patients with chronic liver disease (CLD) with or without cirrhosis, existing studies on the outcomes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have limited generalizability. We used the National COVID Cohort Collaborative (N3C), a harmonized electronic health record dataset of 6.4 million, to describe SARS-CoV-2 outcomes in patients with CLD and cirrhosis. METHODS: We identified all patients with CLD with or without cirrhosis who had SARS-CoV-2 testing in the N3C Data Enclave as of July 1, 2021. We used survival analyses to associate SARS-CoV-2 infection, presence of cirrhosis, and clinical factors with the primary outcome of 30-day mortality. RESULTS: We isolated 220,727 patients with CLD and SARS-CoV-2 test status: 128,864 (58%) were noncirrhosis/negative, 29,446 (13%) were noncirrhosis/positive, 53,476 (24%) were cirrhosis/negative, and 8941 (4%) were cirrhosis/positive patients. Thirty-day all-cause mortality rates were 3.9% in cirrhosis/negative and 8.9% in cirrhosis/positive patients. Compared to cirrhosis/negative patients, cirrhosis/positive patients had 2.38 times adjusted hazard of death at 30 days. Compared to noncirrhosis/positive patients, cirrhosis/positive patients had 3.31 times adjusted hazard of death at 30 days. In stratified analyses among patients with cirrhosis with increased age, obesity, and comorbid conditions (ie, diabetes, heart failure, and pulmonary disease), SARS-CoV-2 infection was associated with increased adjusted hazard of death. CONCLUSIONS: In this study of approximately 221,000 nationally representative, diverse, and sex-balanced patients with CLD; we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.38 times mortality hazard, and the presence of cirrhosis among patients with CLD infected with SARS-CoV-2 was associated with 3.31 times mortality hazard. These results provide an additional impetus for increasing vaccination uptake and further research regarding immune responses to vaccines in patients with severe liver disease.
引用
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页码:1487 / +
页数:20
相关论文
共 46 条
[1]   Response to hepatitis B vaccination in patients with liver cirrhosis [J].
Aggeletopoulou, Ioanna ;
Davoulou, Panagiota ;
Konstantakis, Christos ;
Thomopoulos, Konstantinos ;
Triantos, Christos .
REVIEWS IN MEDICAL VIROLOGY, 2017, 27 (06)
[2]  
[Anonymous], 2018, Global Status Report on Alcohol and Health
[3]  
[Anonymous], 2013, R LANG ENV STAT COMP
[4]  
[Anonymous], 2019, Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths-United States
[5]   Utility of asymptomatic inpatient testing for COVID-19 in a low-prevalence setting: A multicenter point-prevalence study [J].
Bai, Anthony D. ;
Li, Xena X. ;
Alsalem, Mohammed ;
Khan, Sarah ;
Smieja, Marek ;
Mertz, Dominik ;
Chagla, Zain .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2020, 41 (10) :1233-1235
[6]   Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort [J].
Bajaj, Jasmohan S. ;
Garcia-Tsao, Guadalupe ;
Biggins, Scott W. ;
Kamath, Patrick S. ;
Wong, Florence ;
McGeorge, Sara ;
Shaw, Jawaid ;
Pearson, Meredith ;
Chew, Micheal ;
Fagan, Andrew ;
Rodriguez, Randolph de la Rosa ;
Worthington, Janelle ;
Olofson, Amy ;
Weir, Vanessa ;
Trisolini, Calvin ;
Dwyer, Sarah ;
Reddy, K. Rajender .
GUT, 2021, 70 (03) :531-536
[7]  
Bennett Tellen D, 2021, medRxiv, DOI 10.1101/2021.01.12.21249511
[8]  
CDC,, ARDI ALC REL ICD COD
[9]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[10]   Trends in mortality from chronic liver disease [J].
Fedeli, Ugo ;
Avossa, Francesco ;
Guzzinati, Stefano ;
Bovo, Emanuela ;
Saugo, Mario .
ANNALS OF EPIDEMIOLOGY, 2014, 24 (07) :522-526