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Risk factors and outcomes for acute-on-chronic liver failure in COVID-19: a large multi-center observational cohort

Sanjaya K Satapathy1,2, Nitzan C Roth3, Charlotte Kvasnovsky3

  • 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 500 Hofstra Blvd, Hempstead, NY, 11549, USA. ssatapat@northwell.edu.

Hepatology International
|April 7, 2021
PubMed

Insights

COVID-19 patients with chronic liver disease (CLD) face risks, but acute-on-chronic liver failure (ACLF) significantly increases in-hospital mortality, especially in those with cirrhosis. ACLF development, not CLD itself, drives this increased mortality.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Patients with chronic liver disease (CLD) are vulnerable to severe outcomes from COVID-19 infection.
  • Acute-on-chronic liver failure (ACLF) is a known complication in CLD patients, potentially exacerbated by infections.
  • The interplay between COVID-19, CLD, and ACLF requires further investigation to understand mortality drivers.

Purpose of the Study:

  • To analyze outcomes of COVID-19 patients with underlying CLD, including those with and without cirrhosis.
  • To investigate the development and impact of ACLF on in-hospital mortality in this cohort.
  • To identify risk factors associated with ACLF development and mortality in COVID-19 patients with CLD.

Main Methods:

  • A multi-center cohort study identified 192 adult CLD patients among 10,859 COVID-19 patients admitted between March 1, 2020, and April 27, 2020.
  • ACLF was diagnosed using the EASL-CLIF Consortium definition.
  • Patient follow-up extended to April 30, 2020, or until discharge, transfer, or death.

Main Results:

  • Of 84 cirrhosis patients, 38% developed ACLF, commonly presenting with respiratory and renal failure.
  • Hispanic/Latino ethnicity was linked to higher mortality in cirrhosis patients, despite a lower risk of ACLF development.
  • Hypertension predicted ACLF development. In-hospital mortality was significantly higher in cirrhosis patients who developed ACLF compared to those without ACLF, but not different between CLD and non-CLD cohorts.

Conclusions:

  • Development of ACLF is the primary determinant of increased in-hospital mortality in COVID-19 patients with cirrhosis.
  • While CLD itself did not increase mortality compared to controls, ACLF significantly elevated risks.
  • Targeting ACLF prevention and management is crucial for improving outcomes in COVID-19 patients with CLD and cirrhosis.
Abstract

Keywords:
Acute-on-chronic liver failureCOVID-19Chronic liver diseaseCirrhosisLiver chemistriesMortalityOrgan failure

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