Department of Internal Medicine III, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany.
Emergency Department, University Hospital Regensburg, Regensburg, Germany.
United European Gastroenterol J. 2022 May;10(4):409-424. doi: 10.1002/ueg2.12232. Epub 2022 Apr 28.
International registries have reported high mortality rates in patients with liver disease and COVID-19. However, the extent to which comorbidities contribute to excess COVID-19 mortality in cirrhosis is controversial.
We used the multinational Lean European Open Survey on SARS-CoV-2-infected patients (LEOSS) to identify patients with cirrhosis documented between March 2020 and March 2021, when the wild-type and alpha variant were predominant. We compared symptoms, disease progression and mortality after propensity score matching (PSM) for age, sex, obesity, smoking status, and concomitant diseases. Mortality was also compared with that of patients with spontaneous bacterial peritonitis (SBP) without SARS-CoV-2 infection, a common bacterial infection and well-described precipitator of acute-on-chronic liver failure.
Among 7096 patients with SARS-CoV-2 infection eligible for analysis, 70 (0.99%) had cirrhosis, and all were hospitalized. Risk factors for severe COVID-19, such as diabetes, renal disease, and cardiovascular disease were more frequent in patients with cirrhosis. Case fatality rate in patients with cirrhosis was 31.4% with the highest odds of death in patients older than 65 years (43.6% mortality; odds ratio [OR] 4.02; p = 0.018), Child-Pugh class C (57.1%; OR 4.00; p = 0.026), and failure of two or more organs (81.8%; OR 19.93; p = 0.001). After PSM for demographics and comorbidity, the COVID-19 case fatality of patients with cirrhosis did not significantly differ from that of matched patients without cirrhosis (28.8% vs. 26.1%; p = 0.644) and was similar to the 28-day mortality in a comparison group of patients with cirrhosis and SBP (33.3% vs. 31.5%; p = 1.000).
In immunologically naïve patients with cirrhosis, mortality from wild-type SARS-CoV-2 and the alpha variant is high and is largely determined by cirrhosis-associated comorbidities and extrahepatic organ failure.
国际登记处报告称，患有肝病和 COVID-19 的患者死亡率较高。然而，合并症在多大程度上导致肝硬化患者 COVID-19 死亡率过高仍存在争议。
我们使用多国瘦素 SARS-CoV-2 感染患者开放性调查（LEOSS）来确定 2020 年 3 月至 2021 年 3 月期间记录的肝硬化患者，当时野生型和 alpha 变体占主导地位。我们比较了症状、疾病进展和倾向性评分匹配（PSM）后死亡率，PSM 用于匹配年龄、性别、肥胖、吸烟状况和并存疾病。还将死亡率与没有 SARS-CoV-2 感染的自发性细菌性腹膜炎（SBP）患者进行了比较，SBP 是一种常见的细菌感染，也是急性加重慢性肝衰竭的一个明确诱因。
在符合分析条件的 7096 名 SARS-CoV-2 感染患者中，有 70 名（0.99%）患有肝硬化，均住院治疗。肝硬化患者有更多的严重 COVID-19 危险因素，如糖尿病、肾脏疾病和心血管疾病。肝硬化患者的病死率为 31.4%，年龄大于 65 岁的患者死亡风险最高（死亡率为 43.6%；优势比[OR]为 4.02；p=0.018），Child-Pugh 分级为 C（57.1%；OR 为 4.00；p=0.026），以及两个或更多器官衰竭（81.8%；OR 为 19.93；p=0.001）。在 PSM 进行人口统计学和合并症后，肝硬化患者的 COVID-19 病死率与未肝硬化患者无显著差异（28.8%比 26.1%；p=0.644），与肝硬化和 SBP 患者的 28 天死亡率相似（33.3%比 31.5%；p=1.000）。
在免疫初治的肝硬化患者中，野生型 SARS-CoV-2 和 alpha 变体的死亡率较高，主要由肝硬化相关的合并症和肝外器官衰竭决定。
