tetano
Editor, Senior Moderator
Hepatol Int
. 2021 Apr 7.
doi: 10.1007/s12072-021-10181-y. Online ahead of print.
Risk factors and outcomes for acute-on-chronic liver failure in COVID-19: a large multi-center observational cohort study
Sanjaya K Satapathy[SUP] 1 2 [/SUP], Nitzan C Roth[SUP] 3 [/SUP], Charlotte Kvasnovsky[SUP] 3 [/SUP], Jamie S Hirsch[SUP] 3 4 5 [/SUP], Arvind J Trindade[SUP] 3 [/SUP], Ernesto Molmenti[SUP] 3 4 [/SUP], Matthew Barish[SUP] 3 6 4 [/SUP], David Hirschwerk[SUP] 3 [/SUP], Ben L Da[SUP] 3 [/SUP], David Bernstein[SUP] 3 [/SUP], Northwell Health COVID-19 Research Consortium
Affiliations
Abstract
Objective: Coronavirus disease 2019 [COVID-19] infection in patients with chronic liver disease [CLD] may precipitate acute-on-chronic liver failure [ACLF]. In a large multi-center cohort of COVID-19-infected patients, we aim to analyze (1) the outcomes of patients with underlying CLD [with and without cirrhosis] and (2) the development and impact of ACLF on in-hospital mortality.
Design: We identified 192 adults with CLD from among 10,859 patients with confirmed COVID-19 infection (admitted to any of 12 hospitals in a New York health care system between March 1, 2020 and April 27, 2020). ACLF was defined using the EASL-CLIF Consortium definition. Patient follow-up was through April 30, 2020, or until the date of discharge, transfer, or death.
Results: Of the 84 patients with cirrhosis, 32 [38%] developed ACLF, with respiratory failure [39%] and renal failure [26%] being the most common. Hispanic/Latino ethnicity was particularly at higher risk of in-hospital mortality [adjusted HR 4.92, 95% 1.27-19.09, p < 0.02] in cirrhosis despite having lower risk of development of ACLF [HR 0.26, 95% CI 0.08-0.89, p = 0.03]. Hypertension on admission predicted development of ACLF [HR 3.46, 95% CI 1.12-10.75, p = 0.03]. In-hospital mortality was not different between CLD patients with or without cirrhosis [p = 0.24] but was higher in those with cirrhosis who developed ACLF [adjusted HR 9.06, 95% CI 2.63-31.12, p < 0.001] with a trend for increased mortality by grade of ACLF [p = 0.002]. There was no difference in in-hospital mortality between the CLD cohort compared to matched control without CLD (log rank, p = 0.98) and between the cirrhosis cohort compared to matched control without cirrhosis (log rank, p = 0.51).
Conclusion: Development of ACLF is the main driver of increased in-hospital mortality in hospitalized patients with COVID-19 infection and cirrhosis.
Keywords: Acute-on-chronic liver failure; COVID-19; Chronic liver disease; Cirrhosis; Liver chemistries; Mortality; Organ failure.
. 2021 Apr 7.
doi: 10.1007/s12072-021-10181-y. Online ahead of print.
Risk factors and outcomes for acute-on-chronic liver failure in COVID-19: a large multi-center observational cohort study
Sanjaya K Satapathy[SUP] 1 2 [/SUP], Nitzan C Roth[SUP] 3 [/SUP], Charlotte Kvasnovsky[SUP] 3 [/SUP], Jamie S Hirsch[SUP] 3 4 5 [/SUP], Arvind J Trindade[SUP] 3 [/SUP], Ernesto Molmenti[SUP] 3 4 [/SUP], Matthew Barish[SUP] 3 6 4 [/SUP], David Hirschwerk[SUP] 3 [/SUP], Ben L Da[SUP] 3 [/SUP], David Bernstein[SUP] 3 [/SUP], Northwell Health COVID-19 Research Consortium
Affiliations
- PMID: 33826042
- DOI: 10.1007/s12072-021-10181-y
Abstract
Objective: Coronavirus disease 2019 [COVID-19] infection in patients with chronic liver disease [CLD] may precipitate acute-on-chronic liver failure [ACLF]. In a large multi-center cohort of COVID-19-infected patients, we aim to analyze (1) the outcomes of patients with underlying CLD [with and without cirrhosis] and (2) the development and impact of ACLF on in-hospital mortality.
Design: We identified 192 adults with CLD from among 10,859 patients with confirmed COVID-19 infection (admitted to any of 12 hospitals in a New York health care system between March 1, 2020 and April 27, 2020). ACLF was defined using the EASL-CLIF Consortium definition. Patient follow-up was through April 30, 2020, or until the date of discharge, transfer, or death.
Results: Of the 84 patients with cirrhosis, 32 [38%] developed ACLF, with respiratory failure [39%] and renal failure [26%] being the most common. Hispanic/Latino ethnicity was particularly at higher risk of in-hospital mortality [adjusted HR 4.92, 95% 1.27-19.09, p < 0.02] in cirrhosis despite having lower risk of development of ACLF [HR 0.26, 95% CI 0.08-0.89, p = 0.03]. Hypertension on admission predicted development of ACLF [HR 3.46, 95% CI 1.12-10.75, p = 0.03]. In-hospital mortality was not different between CLD patients with or without cirrhosis [p = 0.24] but was higher in those with cirrhosis who developed ACLF [adjusted HR 9.06, 95% CI 2.63-31.12, p < 0.001] with a trend for increased mortality by grade of ACLF [p = 0.002]. There was no difference in in-hospital mortality between the CLD cohort compared to matched control without CLD (log rank, p = 0.98) and between the cirrhosis cohort compared to matched control without cirrhosis (log rank, p = 0.51).
Conclusion: Development of ACLF is the main driver of increased in-hospital mortality in hospitalized patients with COVID-19 infection and cirrhosis.
Keywords: Acute-on-chronic liver failure; COVID-19; Chronic liver disease; Cirrhosis; Liver chemistries; Mortality; Organ failure.