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Cirrhosis and Severe Acute Respiratory Syndrome Coronavirus 2 Infection in US Veterans: Risk of Infection, Hospitalization, Ventilation, and Mortality.
Ioannou, George N; Liang, Peter S; Locke, Emily; Green, Pamela; Berry, Kristin; O'Hare, Ann M; Shah, Javeed A; Crothers, Kristina; Eastment, McKenna C; Fan, Vincent S; Dominitz, Jason A.
  • Ioannou GN; Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
  • Liang PS; Division of Gastroenterology, Veterans Affairs New York Harbor Health Care System and NYU Langone Health, New York, NY.
  • Locke E; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
  • Green P; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
  • Berry K; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
  • O'Hare AM; Division of Nephrology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
  • Shah JA; Division of Allergy and Infectious Disease, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
  • Crothers K; Division of Pulmonary and Critical Care, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
  • Eastment MC; Division of Allergy and Infectious Disease, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
  • Fan VS; Division of Pulmonary and Critical Care, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
  • Dominitz JA; Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
Hepatology ; 74(1): 322-335, 2021 07.
Article in English | MEDLINE | ID: covidwho-1384170
Semantic information from SemMedBD (by NLM)
1. Cirrhosis PROCESS_OF Veterans
Subject
Cirrhosis
Predicate
PROCESS_OF
Object
Veterans
2. COVID-19 PROCESS_OF Veterans
Subject
COVID-19
Predicate
PROCESS_OF
Object
Veterans
3. Increased risk PROCESS_OF Patients
Subject
Increased risk
Predicate
PROCESS_OF
Object
Patients
4. Cirrhosis PROCESS_OF Patients
Subject
Cirrhosis
Predicate
PROCESS_OF
Object
Patients
5. Mechanical ventilation TREATS 4 times
Subject
Mechanical ventilation
Predicate
TREATS
Object
4 times
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. Cirrhosis PROCESS_OF Veterans
Subject
Cirrhosis
Predicate
PROCESS_OF
Object
Veterans
8. COVID-19 PROCESS_OF Veterans
Subject
COVID-19
Predicate
PROCESS_OF
Object
Veterans
9. Increased risk PROCESS_OF Patients
Subject
Increased risk
Predicate
PROCESS_OF
Object
Patients
10. Cirrhosis PROCESS_OF Patients
Subject
Cirrhosis
Predicate
PROCESS_OF
Object
Patients
11. Mechanical ventilation TREATS 4 times
Subject
Mechanical ventilation
Predicate
TREATS
Object
4 times
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
BACKGROUND AND

AIMS:

Whether patients with cirrhosis have increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the extent to which infection and cirrhosis increase the risk of adverse patient outcomes remain unclear. APPROACH AND

RESULTS:

We identified 88,747 patients tested for SARS-CoV-2 between March 1, 2020, and May 14, 2020, in the Veterans Affairs (VA) national health care system, including 75,315 with no cirrhosis-SARS-CoV-2-negative (C0-S0), 9,826 with no cirrhosis-SARS-CoV-2-positive (C0-S1), 3,301 with cirrhosis-SARS-CoV-2-negative (C1-S0), and 305 with cirrhosis-SARS-CoV-2-positive (C1-S1). Patients were followed through June 22, 2020. Hospitalization, mechanical ventilation, and death were modeled in time-to-event analyses using Cox proportional hazards regression. Patients with cirrhosis were less likely to test positive than patients without cirrhosis (8.5% vs. 11.5%; adjusted odds ratio, 0.83; 95% CI, 0.69-0.99). Thirty-day mortality and ventilation rates increased progressively from C0-S0 (2.3% and 1.6%) to C1-S0 (5.2% and 3.6%) to C0-S1 (10.6% and 6.5%) and to C1-S1 (17.1% and 13.0%). Among patients with cirrhosis, those who tested positive for SARS-CoV-2 were 4.1 times more likely to undergo mechanical ventilation (adjusted hazard ratio [aHR], 4.12; 95% CI, 2.79-6.10) and 3.5 times more likely to die (aHR, 3.54; 95% CI, 2.55-4.90) than those who tested negative. Among patients with SARS-CoV-2 infection, those with cirrhosis were more likely to be hospitalized (aHR, 1.37; 95% CI, 1.12-1.66), undergo ventilation (aHR, 1.61; 95% CI, 1.05-2.46) or die (aHR, 1.65; 95% CI, 1.18-2.30) than patients without cirrhosis. Among patients with cirrhosis and SARS-CoV-2 infection, the most important predictors of mortality were advanced age, cirrhosis decompensation, and high Model for End-Stage Liver Disease score.

CONCLUSIONS:

SARS-CoV-2 infection was associated with a 3.5-fold increase in mortality in patients with cirrhosis. Cirrhosis was associated with a 1.7-fold increase in mortality in patients with SARS-CoV-2 infection.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / SARS-CoV-2 / COVID-19 / Liver Cirrhosis Type of study: Etiology study / Prognostic study / Risk factors Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: Hepatology Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / SARS-CoV-2 / COVID-19 / Liver Cirrhosis Type of study: Etiology study / Prognostic study / Risk factors Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: Hepatology Year: 2021 Document Type: Article