Liver Disease Tied to Increased Risk of Death From Severe COVID

Hospitalized COVID-19 patients in France had a higher risk of mechanical ventilation or death if they had chronic liver disease (CLD), a retrospective study found.

Likelihood of ventilation increased by 54% when COVID inpatients had CLD (adjusted odds ratio [aOR] 1.54, 95% CI 1.44-1.64, P<0.001) while the chance of death at 30 days increased by 79% (aOR 1.79, 95% CI 1.71-1.87, P<0.001), reported Vincent Mallet, MD, PhD, of Assistance Publique-Hopitaux de Paris, who presented the data at the European Association for the Study of the Liver (EASL) meeting.

Potentially reduced access to mechanical ventilation among patients with cirrhosis, prior liver-related complications, or alcohol use disorder may have resulted in excess mortality in these groups, according to the findings, which were also recently published in the Journal of Hepatology.

Meanwhile, compensated cirrhosis, mild liver disease, hepatitis, prior liver transplantation, and HIV-positive status were not associated with an increased risk for death due to COVID-19, the study found.

“These findings are consistent with my clinic experience. I have seen patients with advanced liver disease showing greater mortality with COVID-19 infections than other patients,” David W. Victor III, MD, of Houston Methodist Hospital, told MedPage Today. In contrast to the study findings, he noted that “this is further accentuated in organ transplant recipients, especially in the first year of transplantation.”

Mallet stated during a press conference that the study, which represents the largest on liver disease and COVID-19 mortality, reveals some of the health inequities in France.

“COVID-19 death of liver patients was associated with a limitation in the therapeutic effort,” he told MedPage Today. “We want the big picture for France, and to study health equity,” he added, pointing to inequities of COVID-19 mortality and healthcare access among low-wage workers and minorities in the U.S.

For their study, researchers examined 2020 discharge data from 2,187 hospitals on 259,110 adult patients to measure the effect of CLD and alcohol use disorders on COVID-19. Primary exposures included CLD, compensated or advanced liver disease, as well as alcohol use disorders prior to COVID-19. The main outcome was mortality at 30 days and the use of mechanical ventilation.

Average patient age was 70, and 52% were men. Patients were included if they had an associated COVID-19 diagnostic code. Overall, 6% of patients had CLD, 5.7% had alcohol use disorder, 4.6% had primary liver cancer, and 2.1% had a prior liver transplant.

Risk factors for CLD included being male and older age (50 to 80). Of the CLD patients, 10% required mechanical ventilation. The majority of patients who required mechanical ventilation had a history of smoking, hypertension, obesity, or diabetes.

Risk factors for in-hospital mortality within 30 days from COVID-19 included being male, 70 or older, or having an alcohol use disorder, diabetes, hypertension, or a Charlson comorbidity index score above 2.

Aside from CLD, other liver-related factors associated with COVID-19 death included alcoholic liver disease, compensated or decompensated cirrhosis, and liver cancer.

Among patients with CLD, 8.7% were hospitalized due to COVID-19. Among those admitted, 24.1% died and 63.9% experienced liver-related complications. In patients with alcohol use disorders, 8.1% died, with over half of the deaths attributable to liver-related complications.

“Patients with alcohol use disorders had a higher odds of dying and a lower odds of mechanical ventilation,” said Mallet. “The rate of mechanical ventilation was lower, but consistent with the risk of dying for chronic liver disease, along with mild liver disease and compensated cirrhosis.”

“But for decompensated cirrhosis, primary liver cancer, the risk for mechanical ventilation was negative and the risk for dying was positive,” he added. “It was the same for patients with a Charlson comorbidity index score of more than 4.”

Mallet concluded that CLD and alcohol use disorder patients should be prioritized for vaccination.

Limitations of the study included the low prevalence of CLD, and that data was collected from a database as opposed to direct medical records. Conclusions can also only be applied to inpatients.