COVID-19 poses threat for cirrhotics

In cirrhotic patients, the novel coronavirus disease (COVID-19) is linked to the deterioration of liver function and greater mortality, a new study has found.

Researchers conducted a multicentre retrospective analysis on 50 cirrhotic patients (median age, 67 years; 70 percent male) with SARS-CoV-2 infection, as confirmed by reverse-transcriptase polymerase chain reaction.

Compared with either the last outpatient visit or with a blood test prior to admission, liver parameters had changed at COVID-19 diagnosis. For instance, bilirubin (p=0.026), creatinine (p=0.007), international normalized ratio (p=0.042), and alanine aminotransferase (ALT; p=0.024) all significantly increased. Albumin concentrations, on the other hand, decreased (p=0.0003).

These changes influenced scores on the Model for End-Stage Liver Disease (MELD), such that the percentage of patients with score ≥15 doubled from 13 percent to 26 percent (p=0.037). Almost half of the patients decompensated.

Ten patients (45 percent) developed acute liver injuries despite having persistently normal ALT levels, and six patients (12 percent) experienced a hepatitis flare. There were no instances of upper gastrointestinal bleeding.

Seventeen patients died from SARS-CoV-2 infection, yielding a 34-percent 30-day cumulative probability of overall mortality. In most of these deaths (71 percent; n=12), COVID-19 with respiratory failure was considered the cause, while end-stage liver disease was the principal reason for mortality in the remaining five deaths.

Multivariate analysis found that moderate/severe lung failure was a significant predictor of mortality (hazard ratio [HR], 1.950, 95 percent confidence interval [CI], 1.279–2.974; p=0.002), as was the MELD score (HR, 1.094, 95 percent CI, 1.047–1.144; p≤0.0001).

“[A]s the current pandemic of SARS-CoV-2 is spreading, physicians and hepatologists should be aware of the potential detrimental effects of this infection on the short-term outcome of such a fragile patient population as cirrhotics,” researchers said.