Division of Gastroenterology and Hepatology, Department of Medicine , University of California-San Francisco , San Francisco , California , USA.
Department of Epidemiology and Biostatistics , University of California-San Francisco , San Francisco , California , USA.
Hepatology. 2023 Mar 1;77(3):834-850. doi: 10.1002/hep.32780. Epub 2023 Feb 17.
Outcomes of breakthrough SARS-CoV-2 infections have not been well characterized in non-veteran vaccinated patients with chronic liver diseases (CLD). We used the National COVID Cohort Collaborative (N3C) to describe these outcomes.
We identified all CLD patients with or without cirrhosis who had SARS-CoV-2 testing in the N3C Data Enclave as of January 15, 2022. We used Poisson regression to estimate incidence rates of breakthrough infections and Cox survival analyses to associate vaccination status with all-cause mortality at 30 days among infected CLD patients. We isolated 278,457 total CLD patients: 43,079 (15%) vaccinated and 235,378 (85%) unvaccinated. Of 43,079 vaccinated patients, 32,838 (76%) were without cirrhosis and 10,441 (24%) with cirrhosis. Breakthrough infection incidences were 5.4 and 4.9 per 1000 person-months for fully vaccinated CLD patients without cirrhosis and with cirrhosis, respectively. Of the 68,048 unvaccinated and 10,441 vaccinated CLD patients with cirrhosis, 15% and 3.7%, respectively, developed SARS-CoV-2 infection. The 30-day outcome of mechanical ventilation or death after SARS-CoV-2 infection for unvaccinated and vaccinated CLD patients with cirrhosis were 15.2% and 7.7%, respectively. Compared to unvaccinated patients with cirrhosis, full vaccination was associated with a 0.34-times adjusted hazard of death at 30 days.
In this N3C study, breakthrough infection rates were similar among CLD patients with and without cirrhosis. Full vaccination was associated with a 66% reduction in risk of all-cause mortality for breakthrough infection among CLD patients with cirrhosis. These results provide an additional impetus for increasing vaccination uptake in CLD populations.
在未接种疫苗的慢性肝病（CLD）患者中，突破性 SARS-CoV-2 感染的结果尚未得到很好的描述。我们使用国家 COVID 队列协作（N3C）来描述这些结果。
我们在截至 2022 年 1 月 15 日，从 N3C 数据飞地中确定了所有患有或不患有肝硬化的 CLD 患者，他们进行了 SARS-CoV-2 检测。我们使用泊松回归估计突破性感染的发病率，并使用 Cox 生存分析来关联感染 CLD 患者 30 天内的全因死亡率与疫苗接种状态。我们分离了 278457 例 CLD 患者：43079 例（15%）接种了疫苗，235378 例（85%）未接种疫苗。在 43079 例接种疫苗的患者中，32838 例（76%）没有肝硬化，10441 例（24%）有肝硬化。完全接种疫苗的无肝硬化和肝硬化的 CLD 患者的突破性感染发生率分别为每 1000 人-月 5.4 和 4.9 例。在未接种疫苗和接种疫苗的 68048 例和 10441 例肝硬化 CLD 患者中，分别有 15%和 3.7%发生了 SARS-CoV-2 感染。未接种疫苗和接种疫苗的肝硬化 CLD 患者在 SARS-CoV-2 感染后的机械通气或死亡的 30 天结局分别为 15.2%和 7.7%。与未接种疫苗的肝硬化患者相比，完全接种疫苗与 30 天内死亡的调整后危险比降低了 0.34 倍。
在这项 N3C 研究中，有和没有肝硬化的 CLD 患者的突破性感染率相似。完全接种疫苗与肝硬化 CLD 患者突破性感染的全因死亡率降低 66%相关。这些结果为增加 CLD 人群的疫苗接种率提供了额外的动力。
