Chronic liver disease, COVID-19 linked to higher rates of morbidity, mortality

Investigators observed higher rates of morbidity and mortality in patients with chronic liver disease with COVID-19, according to a presenter at The Liver Meeting Digital Experience.

“This pandemic has created stress in a lot of different areas from job loss, depression and anxiety, lack of social interaction, decrease access to medical care; and all these things can potentially lead to increased alcohol use,” Nia Adeniji, M.Eng, from Stanford University School of Medicine, said during her presentation. “Encourage your patients to abstain from excessive alcohol use during this pandemic especially since alcoholic liver disease is associated with worse COVID-19-realted mortality.”

Between March 1, 2020, and May 30, 2020, Adeniji and colleagues performed a multicenter, observation study that included 21 institutions with 867 patients with chronic liver disease with laboratory confirmed COVID-19. Researchers used multivariate logistic regression to identified independent predictors of all-cause mortality, COVID-19 related mortality and composite endpoint of severe COVID-19 in patients with chronic liver disease.

Results showed all-cause mortality was 13.1% overall in 114 patients and 61.4% of patients had severe COVID-19. Patients who presented with diarrhea or nausea/vomiting were more likely to have severe COVID-19, according to Adeniji.

“We did see that patients who presented with diarrhea and nausea and vomiting did have more severe COVID-19 and these symptoms were associated with more severe COVID-19,” she said. “Importantly, [they] were not associated with higher rates of mortality.”

Alcoholic-related liver disease, decompensated cirrhosis and hepatocellular carcinoma were among the liver-specific factors correlated with independent risk of all-cause mortality. Increasing age, hypertension and chronic obstructive pulmonary disease were other risk factors, according to Adeniji. Factors that predicted the risk for severe COVID-19 included Hispanic ethnicity and decompensated cirrhosis.

“We found in patients with chronic liver disease, racial and ethnic distribution and sex did not impact rates of ICU admission and rates of death,” Adeniji said.

In a subgroup analysis of patients with cirrhosis and COVID-19, liver-specific factors correlated with higher all-cause mortality among those with cirrhosis were prior hepatic decompensation (OR = 4.08; 95% CI, 1.99-8.37), HCC (OR = 6.09; 95% CI, 1 83-20.28) and current daily alcohol consumption (OR = 3.72; 95% CI, 1.56-8.87).