Decreasing Case Fatality Rates for Patients With Cirrhosis Infected With SARS-CoV-2: A National COVID Cohort Collaborative Study

Abstract

The virulence and severity of SARS-CoV-2 infections have decreased over time in the general population due to vaccinations and improved antiviral treatments. Whether a similar trend has occurred in patients with cirrhosis is unclear. We used the National COVID Cohort Collaborative (N3C) to describe the outcomes over time. We utilized the N3C level 3 data set with uncensored dates to identify all chronic liver disease (CLD) patients with and without cirrhosis who had SARS-CoV-2 infection as of November 2023. We described the observed 30-day case fatality rate (CFR) by month of infection. We used adjusted survival analyses to calculate relative hazard of death by month of infection compared to infection at the onset of the COVID-19 pandemic. We identified 117,811 total CLD patients infected with SARS-CoV-2 between 3/2020-11/2023: 27,428 (23%) with cirrhosis and 90,383 (77%) without cirrhosis. The observed 30-day CFRs during the entire study period were 1.1% (1,016) for CLD patients without cirrhosis and 6.3% (1,732) with cirrhosis. Observed 30-day CFRs by month of infection varied throughout the pandemic and showed a sustained downward trend since 2022. Compared to infection in Quarter 2 of 2020 (at the beginning of the pandemic), the adjusted hazards of death at 30 days for infection in Quarter 3 of 2023 were 0.20 (95%CI 0.08-0.50) for CLD patients without cirrhosis and 0.35 (95%CI 0.18-0.69) for CLD patients with cirrhosis. In this N3C study, we found that the observed 30-day CFR decreased progressively for both CLD patients with and without cirrhosis, consistent with broader trends seen in the general population.