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Long-term clinical outcomes of patients with COVID-19 and chronic liver disease: US multicenter COLD study
Elizabeth S Aby1,2, Ghady Moafa3, Nyan Latt3
1Hennepin County Medical Center, Minneapolis, Minnesota, USA.
Insights
Patients with chronic liver disease (CLD) who contracted COVID-19 faced significantly higher long-term mortality and morbidity. Nearly 30% experienced long-COVID-19 symptoms, highlighting the prolonged health impacts.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Chronic liver diseases (CLDs) increase risks for severe COVID-19 outcomes.
- Limited data exists on the long-term health consequences for CLD patients post-COVID-19.
Purpose of the Study:
- To evaluate the long-term clinical outcomes and survival rates of patients with CLD following COVID-19 infection.
- To identify risk factors associated with long-COVID-19 in this patient population.
Main Methods:
- A multicenter, observational cohort study involving adult patients with CLD diagnosed with COVID-19 before May 30, 2020.
- Comparison with a propensity-matched control group of CLD patients without COVID-19, with a median follow-up of 384 days.
Main Results:
- Patients with CLD and COVID-19 exhibited worse long-term survival (HR: 1.69) and higher hospitalization rates (HR: 2.00) compared to controls.
- Long-COVID-19 symptoms were reported by 29.9% of patients; female sex, Hispanic ethnicity, and mechanical ventilation predicted its occurrence.
- Liver-related laboratory parameters improved in survivors post-COVID-19 resolution; 70% of eligible patients received COVID-19 vaccination.
Conclusions:
- COVID-19 imposes a substantial long-term burden of mortality and morbidity on patients with CLD.
- Long-COVID-19 affects a significant portion of CLD patients, underscoring the need for ongoing care and health system preparedness.
Background:
COVID-19 is associated with higher morbidity and mortality in patients with chronic liver diseases (CLDs). However, our understanding of the long-term outcomes of COVID-19 in patients with CLD is limited.
Methods:
We conducted a multicenter, observational cohort study of adult patients with CLD who were diagnosed with COVID-19 before May 30, 2020, to determine long-term clinical outcomes. We used a control group of patients with CLD confirmed negative for COVID-19.
Results:
We followed 666 patients with CLD (median age 58 years, 52.8% male) for a median of 384 (interquartile range: 31-462) days. The long-term mortality was 8.1%; with 3.6% experiencing delayed COVID-19-related mortality. Compared to a propensity-matched control group of patients with CLD without COVID-19 (n=1332), patients with CLD with COVID-19 had worse long-term survival [p<0.001; hazards ratio (HR): 1.69; 95% CI: 1.19-2.41] and higher rate of hospitalization (p<0.001, HR: 2.00, 1.62-2.48) over a 1-year follow-up period. Overall, 29.9% of patients reported symptoms of long-COVID-19. On multivariable analysis, female sex (p=0.05, HR: 2.45, 1.01-2.11), Hispanic ethnicity (p=0.003, HR: 1.94, 1.26-2.99), and severe COVID-19 requiring mechanical ventilation (p=0.028, HR: 1.74, 1.06-2.86) predicted long-COVID-19. In survivors, liver-related laboratory parameters showed significant improvement after COVID-19 resolution. COVID-19 vaccine status was available for 72% (n=470) of patients with CLD and history of COVID-19, of whom, 70% (n=326) had received the COVID-19 vaccine.
Conclusions:
Our large, longitudinal, multicenter study demonstrates a high burden of long-term mortality and morbidity in patients with CLD and COVID-19. Symptoms consistent with long-COVID-19 were present in 30% of patients with CLD. These results illustrate the prolonged implications of COVID-19 both for recovering patients and for health care systems.
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