Wang QuanQiu, Davis Pamela B, Xu Rong
Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, 2103 Cornell Rd, Cleveland 44106, OH, USA.
Center for Clinical Investigation, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
EClinicalMedicine. 2021 Jan;31:100688. doi: 10.1016/j.eclinm.2020.100688. Epub 2020 Dec 22.
Scientific evidence is lacking regarding the risk of patients with chronic liver disease (CLD) for COVID-19, and how these risks are affected by age, gender and race.
We performed a case-control study of electronic health records of 62.2 million patients (age >18 years) in the US up to October 1st, 2020, including 1,034,270 patients with CLD, 16,530 with COVID-19, and 820 with both COVID-19 and CLD. We assessed the risk, disparities, and outcomes of COVID-19 in patients with six major CLDs.
Patients with a recent medical encounter for CLD were at significantly increased risk for COVID-19 compared with patients without CLD, with the strongest effect in patients with chronic non-alcoholic liver disease [adjusted odd ratio (AOR)=13.11, 95% CI: 12.49-13.76, < 0.001] and non-alcoholic cirrhosis (AOR=11.53, 95% CI: 10.69-12.43, < 0.001), followed by chronic hepatitis C (AOR=8.93, 95% CI:8.25-9.66, < 0.001), alcoholic liver damage (AOR=7.05, 95% CI:6.30-7.88, < 0.001), alcoholic liver cirrhosis (AOR=7.00, 95% CI:6.15-7.97, < 0.001) and chronic hepatitis B (AOR=4.37, 95% CI:3.35-5.69, < 0.001). African Americans with CLD were twice more likely to develop COVID-19 than Caucasians. Patients with COVID-19 and a recent encounter for CLD had a death rate of 10.3% (vs. 5.5% among COVID-19 patients without CLD, < 0.001) and a hospitalization rate of 41.0% (vs. 23.9% among COVID-19 patients without CLD, < 0.001).
Patients with CLD, especially African Americans, were at increased risk for COVID-19, highlighting the need to protect these patients from exposure to virus infection.
National Institutes of Health (AG057557, AG061388, AG062272, 1UL1TR002548-01), American Cancer Society (RSG-16-049-01-MPC).
关于慢性肝病（CLD）患者感染新型冠状病毒肺炎（COVID-19）的风险，以及年龄、性别和种族如何影响这些风险，目前缺乏科学证据。
我们对截至2020年10月1日美国6220万年龄大于18岁患者的电子健康记录进行了一项病例对照研究，其中包括1034270例CLD患者、16530例COVID-19患者以及820例同时患有COVID-19和CLD的患者。我们评估了6种主要CLD患者中COVID-19的风险、差异及转归情况。
与无CLD的患者相比，近期有CLD就诊史的患者感染COVID-19的风险显著增加，在慢性非酒精性肝病患者中影响最为显著[调整优势比（AOR）=13.11，95%置信区间（CI）：12.49-13.76，P<0.001]和非酒精性肝硬化患者（AOR=11.53，95%CI：10.69-12.43，P<0.001），其次是慢性丙型肝炎（AOR=8.93，95%CI：8.25-9.66，P<0.001）、酒精性肝损伤（AOR=7.05，95%CI：6.30-7.88，P<0.001）、酒精性肝硬化（AOR=7.00，95%CI：6.15-7.97，P<0.001）和慢性乙型肝炎（AOR=4.37，95%CI：3.35-5.69，P<0.001）。患有CLD的非裔美国人感染COVID-19的可能性是白种人的两倍。近期有CLD就诊史的COVID-19患者死亡率为10.3%（无CLD的COVID-19患者为5.5%，P<0.001），住院率为41.0%（无CLD的COVID-19患者为23.9%，P<0.001）。
CLD患者，尤其是非裔美国人，感染COVID-19的风险增加，这凸显了保护这些患者免受病毒感染的必要性。
美国国立卫生研究院（AG057557、AG061388、AG062272、1UL1TR002548-01）、美国癌症协会（RSG-16-049-01-MPC）。
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