Outcomes of Hospitalized Liver Cirrhosis Patients With COVID-19 Infection: A Retrospective Analysis

Background Patients with liver cirrhosis (LC) are at an increased risk of adverse outcomes associated with coronavirus disease 2019 (COVID-19). Existing studies have demonstrated a higher prevalence of malnutrition among COVID-19 patients. However, there is limited research assessing the impact of malnutrition on COVID-19 patients hospitalized with cirrhosis. Methodology We conducted a retrospective analysis of patients with LC admitted to hospitals in the United States in 2020 using the National Inpatient Sample (NIS) database. We compared in-hospital mortality, the risk for acute kidney injury (AKI), and length of stay (LOS) between malnourished and non-malnourished LC patients with COVID-19. Multivariable logistic regression analysis assessed the independent association between malnutrition in these patients and the outcomes of interest. Results Among 5,192 LC patients with COVID-19 and LC identified in the NIS database, 4,593 (88.5%) were not malnourished, and 599 (11.5%) were malnourished. The median age of non-malnourished patients was 63 (interquartile range (IQR) = 54-72) years, and that of malnourished patients was 64 (IQR = 56-72) years. Examining the baseline characteristics, the following did not have statistically significant differences: sex (male: non-malnourished: 60.4% vs. malnourished: 61.6%) and race (White: 50.5% vs. 49.9%). Malnourished patients with LC and COVID-19 were more likely to have hyponatremia (217; 36.2% vs. 1,200; 26.1%) and chronic kidney disease (CKD) (146; 24.4% vs. 928; 20.2%) but less likely to have hypertension (149; 24.9% vs. 1484; 32.3%), hyperlipidemia (141; 23.5% vs. 1441; 31.3%), obesity (75; 12.5% vs. 1010; 22.0%), and diabetes (53; 8.8% vs. 718; 15.6%). Malnourished patients had a significantly higher in-hospital mortality rate (171; 28.5%) compared to non-malnourished patients (836; 18.2%) (p < 0.001). Malnutrition in LC and COVID-19 patients was associated with an increased risk of in-hospital mortality (adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI) = 1.09-1.69, p < 0.01), AKI (aOR = 1.78, 95% CI = 1.47-2.16, p < 0.01), and LOS (unstandardized coefficient = 5.29, 95% CI = 4.52-6.06, p < 0.01). Conclusions Malnutrition in hospitalized LC patients with COVID-19 was associated with a higher risk of in-hospital mortality, AKI, and LOS. These findings highlight the importance of multidisciplinary management in addressing the nutritional status of COVID-19 patients with LC.