Predictors of Severity and Mortality of Chronic Liver Disease Patients with COVID-19

ABSTRACT

Background: COVID-19 has become a major health emergency worldwide. The characteristics and outcome of COVID-19 in patients with CLD remain unclear. Aims: CLD represents a major disease burden globally. Given this high burden, how different underlying liver conditions influence the outcome in patients with COVID-19 needs to be meticulously evaluated. So, we conducted this study to see the outcome of the patient and to look for predictors of severity and mortality in patients with CLD with COVID-19 infection. Methods: This was a single-center, observational study conducted at a tertiary care center. We recruit 50 consecutive patients of COVID-19 with CLD. Matched comparison group patients with CLD without COVID-19 collected retrospectively from historical data with 12 ratio using stratified sampling. Results: Mean age of the study population was 51 ± 12 years with the majority were male. Most patients (21/50) were presented with predominantly respiratory symptoms of which fever was the most common symptom (85%). Jaundice (70%) was the most common GI symptom. Twenty patients had ACLF. All patients with ACLF were having severe COVID-19 infection and succumb to multi-organ failure. Mortality was double in a patient with CLD with COVID-19 infection than historical control. Diabetes was the only comorbidity which was associated with severe infection. Patients in the severely ill subgroup had higher mortality, high creatinine, and raised D-dimer but lower lymphocytes count. (P <0.05). Multivariate logistic regression for severity showed that only D-dimer reached significance. CURB-65 score on admission and Child Turcotte Pugh score on admission correlates with mortality (P <0.05). Serum D-dimer level and reduced lymphocyte counts were associated with mortality on multivariate analysis. Conclusion: The presence of CLD in covid-19 patients was associated with a poor outcome. Raised D-dimer on admission can predict severe infection. Child-Pugh and CRUB65 scores were highly associated with non-survival among these patients.