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Published on: May 23, 2025
Short-term outcomes of patients with chronic liver disease hospitalised with COVID-19
Ivica Grgurevic1,2,3, Marko Lucijanić2,4, Frane Pastrovic1
1Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia.
Insights
Patients with cirrhosis hospitalized for COVID-19 face significantly higher mortality risks. This study highlights cirrhosis as an independent predictor of poor outcomes in COVID-19 patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Chronic liver disease (CLD) may worsen COVID-19 outcomes.
- Understanding COVID-19 impact on CLD patients is crucial.
Purpose of the Study:
- To analyze the outcomes of hospitalized COVID-19 patients with CLD.
- To identify risk factors for mortality in this population.
Main Methods:
- Retrospective analysis of 4014 COVID-19 hospitalizations over 12 months.
- Identification of CLD and cirrhosis patients using ICD-10 codes.
- 30-day follow-up for ICU admission, mechanical ventilation, and death.
Main Results:
- 110 patients (2.7%) had CLD; 49 (1.2%) had cirrhosis.
- Cirrhosis patients had higher 30-day mortality (45% vs. 73% in matched controls).
- Liver cirrhosis independently predicted a fourfold higher adjusted risk of 30-day mortality.
Conclusions:
- Cirrhosis is a significant independent risk factor for mortality in hospitalized COVID-19 patients.
- CLD alone, without cirrhosis, did not predict worse survival.
Background:
Patients with chronic liver disease (CLD) might have an aggravated course after acquisition of coronavirus disease 2019 (COVID-19).
Aims:
To analyse the outcomes of patients with CLD who were hospitalised due to COVID-19.
Methods:
The medical records of 4014 patients hospitalised because of COVID-19 in a regional referral hospital over a 12-month period were analysed. Patients with CLD were identified based on discharge diagnoses according to the International Classification of Diseases-10th Revision. Patients were followed for 30 days from admission and their outcomes (intensive care unit (ICU) admission, mechanical ventilation (MV) or death) were analysed.
Results:
Of the 4014 patients, 110 (2.7%) had CLD and 49 (1.2%) had cirrhosis. The median age of CLD patients was 67.5 years, 79 (71.8%) were males, 224 (23.5%) were obese, 56 (50.9%) reported alcohol abuse, 24 (21.8%) had non-alcoholic fatty liver disease, 11 (10%) had viral hepatitis and 98 (89.1%) had pneumonia. The median length of hospitalisation was 12 days; 32 (29.1%) patients required ICU admission and 23 (20.9%) patients required MV, while 43 (39.1%) died. In univariate analysis, patients with cirrhosis (45% vs 73%, hazard ratio (HR) = 2.95; P < 0.001), but not those with non-cirrhotic CLD (74% vs 73%; P > 0.05), experienced worse 30-day survival when compared with age, sex and COVID-19 duration-matched cohorts. In a logistic regression analysis conducted on the overall and matched cohorts, liver cirrhosis, but not CLD, predicted inferior survival independently of age, comorbidities and severity of COVID-19, with a fourfold higher adjusted risk of 30-day mortality.
Conclusion:
Cirrhosis is independently associated with higher 30-day mortality of hospitalised patients with COVID-19.
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