Patients with cirrhosis plus COVID-19 have higher mortality rates

Patients with cirrhosis and COVID-19 had higher mortality rates than patients with COVID-19 alone, but similar rates as patients with just cirrhosis, according to research published in Gut.

Jasmohan Bajaj, MD, from Virginia Commonwealth University, and colleagues wrote that patients with cirrhosis are assumed to be high-risk in the setting of COVID-19 due to immune dysfunction and altered gut-liver axis, but data are currently lacking.

“The impact of COVID-19 on in-hospital outcomes in patients with cirrhosis is unclear with respect to mortality and acute-on-chronic liver failure development,” they wrote. “Studies including comparisons with control populations with and without cirrhosis and COVID-19 are limited.”

Researchers compared COVID-19 and cirrhosis characteristics, development of organ failures, acute-on-chronic liver failure and mortality among patients with cirrhosis and COVID-19 (n = 37) with age and sex matched patients with COVID-19 (n = 108) or cirrhosis (n = 127) alone.

Investigators found that patients with COVID-19 and cirrhosis had higher mortality compared with patients with COVID-19 alone (30% vs. 13%; P = .03). However, they did not have a significantly higher mortality than patients with cirrhosis alone (30% vs. 20%).

Patients with COVID-19 and cirrhosis also had worse Charleston Comorbidity Index scores (6.5 vs. 3.3; P < .001), lower presenting gastrointestinal symptoms and higher lactate.

“The mortality in the [cirrhosis plus COVID-19] group might trend even higher than that in the COVID-19 alone group in the future since these patients are likely to be denied potentially effective pharmacological therapy treatment until safety in cirrhosis is demonstrated,” Bajaj and colleagues wrote. “In the meantime, patients with cirrhosis should not be discouraged from seeking essential medical care during this pandemic.”