Which people with chronic liver disease have higher COVID-19 risks?

16 Nov 2020 Keith Alcorn
Originally published on www.infohep.org

Decompensated cirrhosis, alcoholic liver disease and hepatocellular carcinoma each raise the risk of death and severe illness from COVID-19 among people with chronic liver disease, but other liver conditions do not, a US multicentre study presented at the online Liver Meeting shows.

The findings come from one of the largest studies of COVID-19 outcomes in people with liver disease reported so far in the pandemic.

Several studies have shown evidence that chronic liver disease increased the risk of death or liver injury, but it is less clear which forms of liver disease place people at higher risk of death or severe illness from COVID-19.

For example, cirrhosis raised the risk of liver injury in people with chronic liver disease diagnosed with COVID-19 in a study carried out in the Asia-Pacific region. A study of liver disease patients in Europe and North America during the first two months of the pandemic found that cirrhosis greatly increased the risk of dying from COVID-19.

Nia Adeniji of Stanford University reported on findings from the COVID-19 in Chronic Liver Diseases (COLD) study, which collected data on COVID-19 outcomes in people with chronic liver disease at 23 centres in the United States between 1 March and 30 May 2020.

The study identified 867 people with chronic liver disease with laboratory-confirmed SARS-CoV-2 infection. Sixty per cent were hospitalised due to COVID-19. People diagnosed with SARS-CoV-2 had a median age of 59 years and 54% were male.

One hundred and fourteen people died during the study period, almost all due to COVID-19 rather than underlying liver disease

Race and ethnicity did not affect the risk of death, mechanical ventilation or ICU admission but men were significantly more likely to be admitted to hospital with COVID-19 than women, as were Hispanic people.

The most common forms of liver disease in the study population were non-alcoholic fatty liver disease, affecting approximately 60% of cases, hepatitis C affecting around 22%, alcoholic liver disease, present in 14% and hepatitis B (7%).

Around 26% had cirrhosis. In almost 60%, cirrhosis was compensated.

Sixty-one per cent of people diagnosed with SARS-CoV-2 were admitted to hospital with COVID-19, 23% of the entire population required intensive care, 18% required mechanical ventilation and 12% died of COVID-19.

Diarrhoea, nausea, vomiting and anosmia (loss of smell) were significantly more common as symptoms in people with severe COVID-19 but were not associated with higher rates of mortality.

Three liver-related factors – decompensated cirrhosis, alcoholic liver disease and hepatocellular carcinoma – were associated with the risk of death in people diagnosed with SARS-CoV-2 in multivariate analysis, after controlling for age, sex, ethnicity, liver disease status, other underlying conditions, obesity, smoking and alcohol consumption.

As well as increasing the risk of death from COVID-19 (OR 1.80, 95% CI 1.01-3.21), decompensated cirrhosis raised the risk of hospitalisation, intensive care unit admission and mechanical ventilation compared to compensated cirrhosis or other liver disease.

Alcoholic liver disease also raised the risk of death from COVID-19 (OR 3.24, 95% CI 1.64-6.41), hospitalisation, ICU admission and mechanical ventilation. The absence of decompensated cirrhosis did not affect the elevated risk.

People with hepatocellular carcinoma were almost four times more likely to die from COVID-19 than people without (OR 3.31, 95% CI 1.53-7.16) but did not have higher rates of hospitalisation, ICU admission or ventilation.

Physicians should encourage the use of telemedicine in patients with chronic liver disease to reduce the risk of infection and chronic liver disease patients should be prioritised for vaccination, Nia Adeniji said.

Another study looked at COVID-19 risk factors in people with cirrhosis. Researchers in the Asia-Pacific region identified 260 cases of COVID-19 in people with cirrhosis. Of these, 54 died of COVID-19. The researchers found that a higher score, based on the diagnosis of respiratory failure, renal failure, hepatic encephalopathy, higher platelet count and any co-morbidity was associated with an increased risk of death from COVID-19.