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Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies.
Middleton, Paul; Hsu, Catherine; Lythgoe, Mark P.
  • Middleton P; Institute of Clinical Sciences, Imperial College London, London, UK paul.middleton13@imperial.ac.uk.
  • Hsu C; Imperial College Healthcare NHS Trust, London, UK.
  • Lythgoe MP; Department of Surgery & Cancer, Imperial College London, London, UK.
BMJ Open Gastroenterol ; 8(1)2021 10.
Article in English | MEDLINE | ID: covidwho-1484025
ABSTRACT

BACKGROUND:

COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed.

OBJECTIVES:

To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection. DESIGN/

METHOD:

PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model.

RESULTS:

63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI 1.36 to 2.42).

CONCLUSION:

Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid / Vaccines Limits: Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjgast-2021-000739

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid / Vaccines Limits: Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjgast-2021-000739