COVID-19 and chronic liver disease: results from the 1219 patients French registry

The deleterious impact of Coronavirus SARS CoV-2 related Disease (COVID-19) in patients with chronic liver disease (CLD) has been previously described. We report here data from the largest French "real-life" cohort. Patients with CLD regardless of etiology and liver transplant recipients who developed COVID-19 confirmed by a positive PCR and/or an evocative chest CT scan were included. The primary outcome was 30-days mortality. Prognostic factors were analyzed using both uni- and multivariate models in subgroups of transplanted and non-transplanted patients. Between August, 2020, and December, 2021, 1219 patients were included, mostly men (n = 754), median age 61 years, 477 patients with advanced CLD (decompensated (Child-Pugh B or C) in 164 patients); 366 patients were immunocompromised, including 271 organ transplant recipients. Hospitalization in intensive care unit was required in 11% of cases. The median follow-up was 68 days. The overall 30-days mortality was 13% (159 deaths, 62% related to extra-hepatic causes). Among transplant recipients, age was the only independent prognostic factor. In the non-transplanted population, the independent prognostic factors were advanced liver fibrosis (F3 or F4, HR 2.5), obesity (HR 1.56) and age (HR 1.03), whereas immunosuppression was not. Within the subgroup of patients with advanced CLD, decompensation (Child-Pugh B or C) was an independent predictor of mortality (HR 3.8). In conclusion, our results highlight the increased vulnerability of patients with advanced CLD to COVID-19, particularly those with decompensated disease. Conversely, they confirm the absence of excess mortality related to immunosuppression, particularly in organ transplant recipients. Clinical trial registration: Clinical trial (NCT 04,375,670).