Abstract
The mortality and severity in COVID-19 is increased in patients with comorbidities. The aim of this study was to evaluate the severity and mortality in COVID-19 patients with underlying kidney and liver diseases. We retrieved data on the clinical features and primary composite end point of COVID-19 patients from Medline and Embase which had been released from inception by the April 16, 2020. The data on two comorbidities, liver diseases and chronic kidney disease, were pooled and statistically analysed to explain the associated severity and mortality rate. One hundred and forty-two abstracts were screened, and 41 full articles were then read. In total, 22 studies including 5595 COVID-19 patients were included in this study with case fatality rate of 16%. The prevalence of liver diseases and chronic kidney disease (CKD) were 3% (95% CI; 2–3%) and 1% (95% CI; 1–2%), respectively. In patients with COVID-19 and underlying liver diseases, 57.33% (43/75) of cases were severe, with 17.65% mortality, while in CKD patients, 83.93% (47/56) of cases were severe and 53.33% (8/15) mortality was reported. This study found an increased risk of severity and mortality in COVID-19 patients with liver diseases or CKD. This will lead to better clinical management and inform the process of implementing more stringent preventative measures for this group of patients.
Highlights
The 2010 Global Burden of Disease reported that liver diseases were responsible for about 2 million deaths annually, with 50% of these associated with complications due to liver cirrhosis and the other half linked to hepatocellular carcinoma and viral hepatitis [1]
Cirrhosis is an end stage of chronic liver disease often preceded by hepatocellular necrosis and progressive fibrosis triggered by various agents including viral infections and chronic alcohol use [2]
Alcohol-related liver disease, nonalcoholic steatohepatitis and hepatitis B and C have been reported to be the main aetiologies of liver cirrhosis, with an up to 80% mortality rate recorded 1-year after decompensation [3,4]
Summary
The 2010 Global Burden of Disease reported that liver diseases were responsible for about 2 million deaths annually, with 50% of these associated with complications due to liver cirrhosis and the other half linked to hepatocellular carcinoma and viral hepatitis [1]. Despite the availability of vaccines for hepatitis B and the advances in clinical understanding and the management of chronic liver diseases, the global health burden of the disease increased between 1990 and 2017. This rise in health burden was attributed to ageing and an overall increase in the global population [4]
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