Abstract
Background: COVID-19 is a disease caused by infection of SARS-CoV-2 virus which leads to mortality due to respiratory failure. The progression of COVID-19 is more severe in patients with pre-existence morbidities, including liver disease. Recently, a few studie showed that liver cirrhosis patients with COVID-19 had a higher risk of mortality rather than liver cirrhosis patients without COVID-19 infection. Nevertheless, the study of survival COVID-19 in a patient with underlying liver cirrhosis is still limited. The aim of this study is to evaluate the survival of COVID-19 in adult patients with liver cirrhosisMethod: An observational study in Cipto Mangunkusumo Hospital was conducted. Patients with underlying liver cirrhosis between March 2020-January 2021 with positive confirmation of COVID-19 were enrolled in this study. Liver cirrhosis patients without COVID-19 were enrolled as a comparison. Both liver cirrhosis patients with and without COVID-19 were follow up at the time of hospital admission until 30 days outcome. Kaplan Meier and a log-rank test were conducted to evaluate the comparison of survival rate in liver cirrhosis patients with and without COVID-19. Multivariate Cox Proportional Hazard was conducted to identify the independent risk factors related to survival.Results: There were 22 liver cirrhosis patients with COVID-19 and 116 liver cirrhosis patients included in this study. Presentation of gender and age similar both of them. Predominantly males with average age were 57 years ± 13,60 for cirrhosis with COVID-19 patients and 53 years ± 12,75 for without COVID-19. The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19 (35.8% vs. 67.2%, p-value 0.001). Median survival of liver cirrhosis patients with COVID-19 was 4 days (95% CI: 1-8 days), while median survival of liver cirrhosis patients without COVID-19 couldn’t be reached since the survival rate of this group above 50%. Final model Cox PH showed that liver cirrhosis with COVID-19 (HR: 8.99; CI 95%: 4.55 – 17.80, p-value 0.001) and Child-Pugh class C (HR: 5.61; 95% CI: 2.76 – 11.40, p-value 0.001) were the independent risk factors associated with poor survival.Conclusion: The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19. Liver cirrhosis with COVID-19 and Child-Pugh class C were associated with poor survival.
Highlights
Coronavirus disease-2019 (COVID-19) is currently causing a global epidemic worldwide
Study found that virus COVID-19 linked with the binding to angiotensin-converting enzyme-2 (ACE-2) receptors which located in hepatocytes and predispose to direct hepatotoxic injury
The aim of this study is to evaluate the survival of COVID-19 in adult patients with liver cirrhosis
Summary
Coronavirus disease-2019 (COVID-19) is currently causing a global epidemic worldwide. COVID-19 is a disease caused by infection of the SARS-CoV-2 virus which leads to mortality mainly due to respiratory failure and other organ failure. The most common symptoms of COVID-19 is fever, followed by dry cough and tiredness in mild symptom.[3] The progression of COVID-19 is more severe in patients with pre-existence morbidities, including chronic liver disease.[4] Liver cirrhosis (LC) is the end stage of chronic liver disease mainly caused by a viral infection, metabolic fatty liver, or alcohol consumption.[5]. Liver cirrhosis patient who has immune dysfunction might lead to poorer outcome while infected with COVID-19 and predispose as highrisk population for mortality.[6]. Coronavirus disease-2019 (COVID-19) is a disease caused by infection of SARS-CoV-2 virus which leads to mortality due to respiratory failure. The progression of COVID-19 is more severe in patients with pre-existence morbidities, including liver disease. The aim of this study is to evaluate the survival of COVID-19 in adult patients with liver cirrhosis
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