S1139 COVID-19 Experience in Patients With Cirrhosis and Clinically Significant Portal Hypertension

Abstract

Introduction: Patients with underlying cirrhosis have increased mortality from Coronavirus disease 2019 (COVID-19) which correlates with their baseline MELD-Na and Child Turcotte Pugh (CTP) scores.1,2,3 Methods: We performed an institutional review board-approved retrospective review of medical records of all patients with cirrhosis and clinically significant portal hypertension (CSPH) defined by platelet count < 150,000/microL at our institution between 15 March and 15 May of 2020. Results: Of 119 patients with cirrhosis and CSPH, fifteen (12.6%) tested positive for SARS-CoV-2 (12 by nasopharyngeal PCR (GENEXPERT) within our institution; 3 tested positive at outside institutions per patient report). Among both uninfected patients and patients with SARS-CoV-2 infection, a majority of patients had CTP Class A cirrhosis (66.6% vs. 85.6%; p=0.144) (Table 1). Compared to uninfected patients, patients with SARS-CoV-2 infection were younger (median age 67 vs. 70 years; p= 0.010), less likely to be former smokers (20% vs. 49.3%; p=0.034) and had significantly higher MELD-Na scores (median 15 vs. 9; p= 0.001). Of the 12 patients diagnosed with SARS-CoV-2 at our hospital, 4 required supplemental oxygen via nasal cannula or nonrebreather mask on an inpatient medical floor, and 3 had severe disease requiring intubation and mechanical ventilation. Three patients died, two of which had preexisting decompensated liver disease (CTP B or C). None of the patients experienced hepatic decompensating events at the time of their diagnosis or within 90 days of diagnosis. Conclusion: Our single center cohort of patients with cirrhosis and CSPH is in line with previous reports of patients with higher MELD-Na scores being at increased risk of SARS-CoV-2 infection and suggests that patients with decompensated liver disease may have increased mortality from COVID-19.2,3 Compared to previous reports of hepatic decompensation rate of between 37% and 46%,2,3 a key difference in our experience is that no patient experienced hepatic decompensation at the time of their diagnosis or within 90 days of diagnosis. This difference may be explained by our single center experience and small sample size compared to multicenter international studies of larger cohorts.Table 1.: Percent Change in HBV and HCV Incidence from 2010 to 2019 (* p <0.05)