Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN).
Latin American Liver Research Educational and Awareness Network (LALREAN); Liver Section, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina.
Ann Hepatol. 2021 Nov-Dec;25:100350. doi: 10.1016/j.aohep.2021.100350. Epub 2021 Apr 14.
Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality.
We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves.
Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001).
SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.
病毒感染已被描述为增加肝硬化患者失代偿的风险。我们旨在确定 SARS-CoV-2 感染对住院肝硬化患者结局的影响，并比较不同预测死亡率的预后模型的性能。
我们进行了一项前瞻性队列研究，纳入了 2020 年 4 月 15 日至 2020 年 10 月 1 日期间来自拉丁美洲 11 个国家的 38 家医院的 2211 例确诊 SARS-CoV-2 感染住院患者。我们记录了有和无肝硬化患者的临床和实验室参数。所有患者均随访至出院或死亡。我们使用 ROC 曲线评估了不同评分系统预测肝硬化患者死亡率的预后性能。
总体而言，4.6%（3.7-5.6）的患者有肝硬化（n=96）。评估了基线 Child-Turcotte-Pugh（CTP）分级：CTP-A（23%）、CTP-B（45%）和 CTP-C（32%）；中位 MELD-Na 评分为 19（IQR 14-25）。肝硬化患者的死亡率为 47%，无肝硬化患者的死亡率为 16%（P<.0001）。肝硬化与死亡独立相关[比值比 3.1（95%CI 1.9-4.8）；P<.0001]，校正年龄、性别和 BMI>30 后仍有相关性。慢性肝衰竭联盟（CLIF-C）、北美终末期肝病研究联盟（NACSELD）、CTP 评分和 MELD-Na 预测 28 天死亡率的 ROC 曲线下面积分别为 0.85、0.75、0.69、0.67（P<.0001）。
SARS-CoV-2 感染与肝硬化患者死亡率升高相关。CLIF-C 在预测 SARS-CoV-2 感染合并肝硬化患者死亡率方面的性能优于 NACSELD、CTP 和 MELD-Na。临床试验注册：NCT04358380。
