Risk of severe disease and mortality of COVID-19 in patients with Budd-Chiari syndrome: A population-based matched
Arunkumar Krishnan1, Carolin V Schneider2, Jörn M Schattenberg3
1Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Insights
Patients with Budd-Chiari syndrome (BCS) face higher risks of severe COVID-19 outcomes, including hospitalization and mortality. This study highlights the increased vulnerability of BCS patients to coronavirus disease 2019 (COVID-19).
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Budd-Chiari syndrome (BCS) obstructs hepatic outflow, posing potential risks during COVID-19.
- The impact of COVID-19 on BCS patients remains understudied.
- This research assesses COVID-19 severity, mortality, and complications in BCS patients.
Discussion:
- BCS patients with COVID-19 exhibited increased risks for all-cause mortality, severe disease, hospitalization, and acute kidney injury (AKI) compared to non-chronic liver disease (CLD) cohorts.
- While hospitalization and mortality risks were elevated compared to non-BCS CLD patients, severe disease and AKI did not reach statistical significance.
- These findings underscore the heightened vulnerability of BCS patients to adverse COVID-19 outcomes.
Key Insights:
- COVID-19 infection in BCS patients is linked to poorer outcomes.
- BCS patients face significantly higher risks of hospitalization and all-cause mortality post-COVID-19 diagnosis.
- A potential increased risk for severe disease and AKI exists in BCS patients with COVID-19.
Outlook:
- Further research is needed to elucidate the mechanisms behind increased COVID-19 severity in BCS.
- Clinical management strategies for COVID-19 in BCS patients may require specific considerations.
- Long-term follow-up studies can clarify the persistent effects of COVID-19 on BCS patients.
Background & Aims:
Budd-Chiari syndrome (BCS) is a rare and potentially life-threatening disorder characterized by obstruction of the hepatic outflow tract. It is unknown whether patients with BCS represent a high risk for severe disease and mortality from coronavirus disease 2019 (COVID-19). Thus, we aimed to assess hospitalization rates, severe disease, all-cause mortality, intensive care unit (ICU) requirement and acute kidney injury (AKI) from COVID-19 diagnoses.
Methods & Results:
We identified 467 patients with BCS with COVID-19, 96 427 non-chronic liver disease (CLD) and 9652 non-BCS CLD. The BCS and non-CLD cohorts (n = 467 each) and BCS and non-BCS CLD (n = 440 each) were well balanced after propensity matching. When compared to the non-CLD cohort, the BCS group had a higher risk of all-cause mortality (5.1% vs. 2.4%, HR 2.18; 95% CI, 1.08-4.40), severe disease (6.0% vs. 2.4%, HR 2.20; 95% CI, 1.09-4.43), hospitalization (24.6% vs. 13.1%, HR 1.77; 95% CI, 1.30-2.42) and AKI (7.9% vs. 2.8%, HR 2.57; 95% CI, 1.37-4.85), but no significant differences in ICU requirements (2.4% vs. 2.1%, HR 0.75; 95% CI, 0.27-2.08) at 60-days time points. When compared to the non-BCS CLD cohort, the BCS group had a higher risk of all-cause mortality (3.6% vs. 2.5%, HR 3.94; 95% CI, 1.31-11.79), hospitalization (29.8% vs. 21.6%, HR 1.43; 95% CI, 1.09-1.86), but differences in ICU requirements (HR 0.90 (0.38-2.12)), AKI (HR 1.41 (0.86-2.30)) or severe disease (HR 1.92 (0.99-3.71)) did not reach statistical significance at 60-day follow up.
Conclusion:
In conclusion, COVID-19 infection in patients with BCS is associated with poor outcomes. Patients with BCS infected with COVID-19 carry a significantly higher risk of hospitalization and all-cause mortality and a possible effect on severe disease and AKI compared with COVID-19 patients without CLD or with non-BCS-CLD.
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