IMPACT OF COVID-19 ON PATIENTS WITH DECOMPENSATED LIVER CIRRHOSIS

ABSTRACT

Introduction: The aim of this study was to assess the impact of Covid-19 infection on patients with decompensated liver cirrhosis (DLC) in terms of acute-on-chronic liver failure (ACLF), hospitalization and mortality. Material adn method: In this retrospective study we analyzed patients known with DLC and admitted in the Gastroenterology Department with COVID-19 virus. Clinical and biochemical data were obtained to compare the development of ACLF, chronic liver failure- acute decompensation (CLIF-AD), hospitalization and the presence of independent factors of mortality in comparison with a non COVID-19 DLC group. All the patients enrolled were not vaccinated for COVID-19. Variables used in statistical analyses were obtained at the time of hospital admission. Results: Of 145 subjects (mean age 61 years;74.48% males), 31% were confirmed with COVID-19 infection. There were no significant differences in terms of ACLF [35.5% vs. 23%, (p=0.1712)] in COVID- 19 vs. non COVID-19 group, nor between MELD score values (20.62±8.46 vs.18.28±7.59, p=0.0997). After excluding subjects with ACLF, the CLIF-C AD score was calculated and significantly higher values were obtained in COVID-19 subjects (60.52 ±11.74 vs. 9.57 ±6.36, p<0.0001). 53.3% (24/45) of the subject from the COVID-19 group had CLIF-C AD > 60, and 66.7% of them died during admission. The length of hospital stay (days) was significantly longer in patients with COVID-19 infection (11.2±7.85 vs. 5.91±4.74, p<0.0001) and 46.7% (21/45) of the subjects with COVID-19 infection died during admission, while only 15% non COVID-19 died (p=0.0001). In univariate regression analysis CLIF-C AD (p=0.012), Child-Pugh (p=0.012), MELD values (p=0.004), and the presence of infections (p<0.001) were independent predictors of mortality. In multivariate regression analysis, the model including CLIF-C AD values (p=0.0036) and the presence of infections (p=0.0009) was associated with death during admission. Conclusions: COVID- 19 significantly influenced disease progression in patients with DLC in terms of CLIF- C AD, hospitalization and mortality and did not in terms of MELD and ACLF.