Abstract
BackgroundCoronavirus disease 2019 (COVID-19) infection in chronic liver disease patients is associated with poor outcomes. In this study, we aimed to evaluate the predictors of severity and mortality in this group of patients during the second wave of the COVID-19 pandemic in India. In addition, we compared cirrhotic patients with COVID-19 with cirrhotic patients from the pre-COVID-19 period.MethodologyThis was a single-center observational study. We included data from 50 patients with cirrhosis and COVID-19 retrospectively from the discharge/death files. A comparison group of 100 patients with cirrhosis from the pre-COVID period was also analyzed retrospectively.ResultsThe majority of patients had predominantly respiratory symptoms, with fever being the most common symptom (85%). The most common presentation was acute on chronic liver failure (ACLF). The most common form of decompensation was jaundice followed by hepatic encephalopathy. The overall mortality in cirrhotic patients with COVID-19 was double than that in cirrhotic patients from the pre-COVID-19 period. All patients with ACLF succumbed to multiorgan failure. Diabetes was the only comorbidity that was associated with severe infection. Higher creatinine on admission and high D-dimer levels correlated with severity. D-dimer was the only parameter that correlated with severity and mortality on multivariate analysis. None of the comorbidities predicted mortality. Among various composite scores, the Child-Turcotte-Pugh (CTP) score and CURB-65 correlated with mortality. On the area under the receiver operating characteristic analysis, a D-dimer level of >1.1 mg/L was associated with mortality.ConclusionsCOVID-19 infection in patients with cirrhosis is associated with poor outcomes. D-dimer levels of >1.1 mg/L on admission are a simple parameter to predict mortality. CTP and CURB-65 are composite scores that correlate with mortality in this group of patients.
Highlights
Higher creatinine on admission and high D-dimer levels correlated with severity
On the area under the receiver operating characteristic analysis, a D-dimer level of >1.1 mg/L was associated with mortality
COVID-19 infection in patients with cirrhosis is associated with poor outcomes
Summary
In December 2019, patients with unexplained pneumonia were discovered in Wuhan, Hubei Province, China, which was caused by a novel coronavirus [1]. The coronavirus disease 2019 (COVID-19) rapidly spread to the rest of the world including India. After a declining trend of cases during the start of 2021, there was a rapid surge in COVID-19 cases from February 2021 in India, which led to the second wave of the pandemic. The overall incidence of elevated serum liver biochemistries in patients with COVID‐19 ranged from 14% to 53% during the first wave of the pandemic worldwide [5]. Coronavirus disease 2019 (COVID-19) infection in chronic liver disease patients is associated with poor outcomes. We aimed to evaluate the predictors of severity and mortality in this group of patients during the second wave of the COVID-19 pandemic in India. We compared cirrhotic patients with COVID-19 with cirrhotic patients from the pre-COVID-19 period
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