COVID-19 vaccination decreases hospitalization rates in patients with cirrhosis

COVID-19 vaccination correlated with a decreased risk for hospitalization among patients with cirrhosis and other high-risk comorbidities, according to research presented at The Liver Meeting Digital Experience.

“The liver is the second most common organ affected by COVID-19 and mortality due to COVID-19 is higher in cirrhotic patients reaching 32% compared to 8% in the overall population. Mortality is directly associated to the severity of cirrhosis. COVID-19 causes decompensation in 46% of patients with cirrhosis,” Luis Antonio Díaz, MD, of the Pontificia Universidad Católica de Chile School of Medicine, said during the presentation. “An important aspect is that most of the vaccine studies exclude individuals with cirrhosis. On the other side, cirrhotic patients have immune dysregulation and they could have some concerns with the vaccination effectiveness.”

Aimed to investigate the impact of vaccination against COVID-19 in patients with cirrhosis, researchers analyzed data from the Chilean Ministry of Health national SARS-CoV-2 surveillance program. Díaz and colleagues further updated incidence rates and prevalence reports of comorbidities twice a week and used a quasi-experimental design to assess the effect of decreasing hospitalization rates following administration of the second COVID-19 vaccine dose. Regression discontinuity models estimated the impact of vaccinations determined by hospitalization rates.

Among 1,648,680 COVID-19 cases (median age, 38 years; 50.2% women), accounting for an incidence rate of 8,472.9 cases per 100,000 inhabitants, 50.1% received either one dose or two doses of the CoronaVac (Sinovac Life Sciences, Beijing, China) vaccine (79.4%), the BNT162b2 mRNA (Pfizer/BioNTech) vaccine (18.7%) or the Vaxzevria (Oxford-AstraZeneca) vaccine (1.9%). Overall, 0.1% of COVID-19 cases had underlying cirrhosis and 42.9% required hospitalization.

Vaccination among patients with cirrhosis correlated with a decline in hospitalization rates (–12.69; 95% CI, –21.71 to –2.68; P < .01) compared with those who were not vaccinated beyond 2 weeks following the second vaccine dose. This trend was also seen among patients with heart failure, diabetes, hypertension and asthma though the benefit of decreased hospitalization rates was higher in cirrhosis.

“Patients with underlying cirrhosis have a higher hospitalizations rate than the overall population. Our nationwide study showed an association between vaccination against COVID-19 and a lower hospitalization risk in patients with cirrhosis and a similar benefit in other comorbidities,” Díaz concluded. “Those patients are at a higher risk and not safe. Vaccination in high-risk groups is highly encouraged.”