Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
Department of Medicine, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Health Care System, Richmond, Virginia, USA.
Gut. 2021 Mar;70(3):531-536. doi: 10.1136/gutjnl-2020-322118. Epub 2020 Jul 13.
Comorbid conditions are associated with poor prognosis in COVID-19. Registry data show that patients with cirrhosis may be at high risk. However, outcome comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone and cirrhosis alone are lacking. The aim of this study was to perform these comparisons.
A multicentre study of inpatients with cirrhosis+COVID-19 compared with age/gender-matched patients with COVID-19 alone and cirrhosis alone was performed. COVID-19 and cirrhosis characteristics, development of organ failures and acute-on-chronic liver failure (ACLF) and mortality (inpatient death+hospice) were compared.
37 patients with cirrhosis+COVID-19 were matched with 108 patients with COVID-19 and 127 patients with cirrhosis from seven sites. Race/ethnicity were similar. Patients with cirrhosis+COVID-19 had higher mortality compared with patients with COVID-19 (30% vs 13%, p=0.03) but not between patients with cirrhosis+COVID-19 and patients with cirrhosis (30% vs 20%, p=0.16). Patients with cirrhosis+COVID-19 versus patients with COVID-19 alone had equivalent respiratory symptoms, chest findings and rates of intensive care unit transfer and ventilation. However, patients with cirrhosis+COVID-19 had worse Charlson Comorbidity Index (CCI 6.5±3.1 vs 3.3±2.5, p<0.001), lower presenting GI symptoms and higher lactate. Patients with cirrhosis alone had higher cirrhosis-related complications, maximum model for end-stage liver disease (MELD) score and lower BiPAP/ventilation requirement compared with patients with cirrhosis+COVID-19, but CCI and ACLF rates were similar. In the entire group, CCI (OR 1.23, 95% CI 1.11 to 1.37, p<0.0001) was the only variable predictive of mortality on multivariable regression.
In this multicentre North American contemporaneously enrolled study, age/gender-matched patients with cirrhosis+COVID-19 had similar mortality compared with patients with cirrhosis alone but higher than patients with COVID-19 alone. CCI was the only independent mortality predictor in the entire matched cohort.
合并症与 COVID-19 的预后不良有关。登记数据显示，肝硬化患者可能面临高风险。然而，肝硬化合并 COVID-19 患者与单纯 COVID-19 患者和单纯肝硬化患者之间的预后比较尚缺乏。本研究旨在进行这些比较。
对来自七个中心的肝硬化合并 COVID-19 住院患者与年龄/性别匹配的单纯 COVID-19 患者和单纯肝硬化患者进行了一项多中心研究。比较了 COVID-19 和肝硬化特征、器官衰竭和慢加急性肝衰竭（ACLF）的发生以及死亡率（住院死亡+临终关怀）。
37 例肝硬化合并 COVID-19 患者与来自七个中心的 108 例单纯 COVID-19 患者和 127 例单纯肝硬化患者相匹配。种族/民族相似。与单纯 COVID-19 患者（30%比 13%，p=0.03）相比，肝硬化合并 COVID-19 患者的死亡率更高，但与单纯肝硬化患者（30%比 20%，p=0.16）相比无差异。与单纯 COVID-19 患者相比，肝硬化合并 COVID-19 患者具有相似的呼吸系统症状、胸部表现和转入重症监护病房及通气的比例。然而，肝硬化合并 COVID-19 患者的 Charlson 合并症指数（CCI 6.5±3.1 比 3.3±2.5，p<0.001）更高，上消化道症状更少，血乳酸水平更高。单纯肝硬化患者的肝硬化相关并发症、最大终末期肝病模型（MELD）评分更高，比因肝硬化合并 COVID-19 患者需要 BiPAP/通气的比例更低，但 CCI 和 ACLF 发生率相似。在整个组中，CCI（比值比 1.23，95%可信区间 1.11 至 1.37，p<0.0001）是多变量回归分析中唯一预测死亡率的变量。
在这项多中心、北美同期纳入的研究中，年龄/性别匹配的肝硬化合并 COVID-19 患者的死亡率与单纯肝硬化患者相似，但高于单纯 COVID-19 患者。CCI 是整个匹配队列中唯一的独立死亡率预测因素。
