Outcomes in COVID-19 patients with and without preexisting chronic liver disease: A retrospective study

ABSTRACT

Background: Many patients with COVID-19 also present with liver injury, in addition to respiratory symptoms. There is concern that COVID-19 could lead to more severe clinical outcomes in patients with comorbid chronic liver disease and vice versa. Evaluation of demographic data and the clinical COVID-19 disease course in this subset of patients is warranted due to the rapid and severe nature of the virus. Methods: A retrospective cohort study was conducted on patients infected with COVID-19, with and without chronic liver disease, from March 22nd, 2020, to August 1, 2020. A randomized list of 450 patients without (NLD) and 225 patients with chronic liver disease (LD) was compiled and matched on age, gender, and BMI into 150 patient pairs. Six patients were disqualified for not meeting inclusion criteria, resulting in a final number of 147 patients in each cohort. Demographic, clinical, and laboratory data was collected at baseline and post-COVID-19 infection. Descriptive statistics and bivariate analyses were also conducted. IRB approval was obtained prior to the data collection process. Results: Our cohort averaged 59.32 years of age, were 48.98% male and 51.02% female, and had an average BMI of 31.27. The most common causes of chronic liver disease were non-alcoholic fatty liver disease (62.59%) and Hepatitis C (20.41%). Patients with cirrhosis made up 15.65% of the cohort. LD patients were more likely to have comorbidities like hypertension and hyperlipidemia. NLD patients were more likely to have respiratory symptoms than LD patients, who were more likely to have GI symptoms. In a comparison of laboratory results, the LD group had statistically significantly higher baseline and follow up AST levels compared to the NLD group. However, post COVID-19 infection, both groups had a statistically significant increase in AST. NLD patients also had statistically significant increases in creatinine and ALT compared to baseline. Overall mortality rate in the cohort of 294 patients was 10.54%, with a higher mortality in the NLD group, albeit not statistically significant. The incidence of mortality for patients with cirrhosis was 10%. Conclusion: This study found that LD patients were more likely to experience GI symptoms than respiratory symptoms, which were more common in NLD patients. Both groups developed increased liver enzymes post-COVID infection. LD patients were more likely to have metabolic disease as expected, given NAFLD as the main underlying liver disease. Though LD patients had these comorbidities, there was no statistically significant difference in rate of hospitalization, ICU admissions, or mortality between the groups. This could possibly be explained by the high rate of obesity in both groups (average BMI 31). There was also a small percentage of patients with cirrhosis, the majority of whom were well compensated. Further studies are needed to determine the risk of COVID-19 in patients with chronic liver disease and cirrhosis.