CIRRHOSIS IS ASSOCIATED WITH SIGNIFICANTLY WORSENED CLINICAL OUTCOMES OF COVID-19 INFECTION IN A RETROSPECTIVE ANALYSIS OF 23,474 PATIENTS ACROSS 143 HOSPITALS

ABSTRACT

Coronavirus disease 2019 (COVID-19) has been diagnosed in at least 63.5 million individuals and resulted in 1.4 million deaths as of December 2020 since its discovery. Various risk factors for severe illness have been investigated;currently it is understood that cardiovascular disease, diabetes mellitus, hypertension, chronic lung disease, malignancy, chronic renal disease, obesity, and smoking confer worse outcomes. Liver cirrhosis is understood to be a significant source of general morbidity and mortality due, in part, to compromise of the immune system. A multicenter, retrospective examination of 50 patients with both COVID-19 and cirrhosis showed that patients with cirrhosis were at increased risk for mortality from COVID-19 than those without cirrhosis. To our knowledge, there exists no large study to examine the effect of cirrhosis on COVID-19 outcomes. We performed a multicenter, retrospective study to further examine outcomes in cirrhotic patients hospitalized for COVID-19 infection. Using the HCA Healthcare Physician Services clinical data warehouse, we reviewed 23,474 adult patients across 143 hospitals admitted from January through August 2020 with COVID-19, yielding 22,467 COVID-19 patients without cirrhosis and 1,007 with cirrhosis. Unpaired T-tests of COVID-19 patients with cirrhosis compared to those without cirrhosis showed that patients with both COVID-19 and cirrhosis experienced significantly higher mortality (17.97% vs 12.96%, p<0.001), significantly higher rates of ICU admission (45.58% vs 33.90%, p<0.001), significantly higher rates of ventilation (24.43% vs 16.07%, p<0.001), and significantly longer lengths of stay (LOS) (11.05 ± 10.86 vs 8.46 ± 10.05 days, p<0.001). The outcomes of ICU admission and length of stay remained significant on paired T-test when the 1,007 patients with COVID-19 and cirrhosis were age-matched to COVID-19 patients without cirrhosis. Cirrhosis was independently associated with increased mortality (OR 1.33, CI 1.11-1.58, p=0.002), ICU admission (OR 2.08, CI 1.16-1.52, p<0.001), and ventilation (OR 1.32, CI 1.13-1.54, p<0.001) on multivariable regression analysis. Our dataset corroborates previous studies suggesting protective effects of female sex;and deleterious effects of increasing age, myocardial infarction, cerebrovascular disease, diabetes, cancer, and obesity. Chronic pulmonary disease was significantly associated with poor outcomes of all measures except mortality. Additionally, length of stay among patients with both COVID and cirrhosis is estimated to increase by 1.65 (SE 0.31, p<0.001) on linear regression analysis. In summary, patients with both cirrhosis and COVID-19 experienced significantly increased rates of mortality, ICU admission, ventilation, and lengths of stay compared to patients with COVID-19 alone. (Table presented.)