UMMS Affiliation
UMass Center for Clinical and Translational Science
Publication Date
2021-06-07
Document Type
Article Preprint
Disciplines
Digestive System Diseases | Epidemiology | Gastroenterology | Hepatology | Infectious Disease | Translational Medical Research | Virus Diseases
Abstract
Background and Aims In patients with chronic liver diseases (CLD) with or without cirrhosis, existing data on the risk of adverse outcomes with SARS-CoV-2 infection have been mixed or have limited generalizability. We used the National COVID Cohort Collaborative (N3C) Data Enclave, a harmonized electronic health record (EHR) dataset of 5.9 million nationally-representative, diverse, and gender-balanced patients, to describe outcomes in patients with CLD and cirrhosis with SARS-CoV-2.
Methods We identified all chronic liver diseases patients with and without cirrhosis who had SARS-CoV-2 testing documented in the N3C Data Enclave as of data release date 5/15/2021. The primary outcome was 30-day all-cause mortality. Survival analysis methods were used to estimate cumulative incidences of death, hospitalization, and mechanical ventilation, and to calculate the associations of SARS-CoV-2 infection, presence of cirrhosis, and demographic and clinical factors to 30-day mortality.
Results We isolated 217,143 patients with CLD: 129,097 (59%) without cirrhosis and SARS-CoV-2 negative, 25,844 (12%) without cirrhosis and SARS-CoV-2 positive, 54,065 (25%) with cirrhosis and SARS-CoV-2 negative, and 8,137 (4%) with cirrhosis and SARS-CoV-2 positive. Among CLD patients without cirrhosis, 30-day all-cause mortality rates were 0.4% in SARS-CoV-2 negative patients and 1.8% in positive patients. Among CLD patients with cirrhosis, 30-day all-cause mortality rates were 4.0% in SARS-CoV-2 negative patients and 9.7% in positive patients.
Compared to those who tested SARS-CoV-2 negative, SARS-CoV-2 positivity was associated with more than two-fold (aHR 2.43, 95% CI 2.23-2.64) hazard of death at 30 days among patients with cirrhosis. Compared to patients without cirrhosis, the presence of cirrhosis was associated with a three-fold (aHR 3.39, 95% CI 2.96-3.89) hazard of death at 30 days among patients who tested SARS-CoV-2 positive. Age (aHR 1.03 per year, 95% CI 1.03-1.04) was associated with death at 30 days among patients with cirrhosis who were SARS-CoV-2 positive.
Conclusions In this study of nearly 220,000 CLD patients, we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.43-times mortality hazard, and the presence of cirrhosis among CLD patients infected with SARS-CoV-2 were associated with 3.39-times mortality hazard. Compared to previous studies, our use of a nationally-representative, diverse, and gender-balanced dataset enables wide generalizability of these findings.
Keywords
SARS-CoV-2 Infection, COVID-19, Chronic Liver Disease, Cirrhosis, mortality, UMCCTS funding
Rights and Permissions
The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
DOI of Published Version
10.1101/2021.06.03.21258312
Source
medRxiv 2021.06.03.21258312; doi: https://doi.org/10.1101/2021.06.03.21258312. Link to preprint on medRxiv
Journal/Book/Conference Title
medRxiv
Related Resources
Now published in Gastroenterology, doi:10.1053/j.gastro.2021.07.010
Repository Citation
Ge J, Pletcher MJ, Lai JC, N3C Consortium. (2021). Outcomes of SARS-CoV-2 Infection in Patients with Chronic Liver Disease and Cirrhosis: a N3C Study [preprint]. UMass Center for Clinical and Translational Science Supported Publications. https://doi.org/10.1101/2021.06.03.21258312. Retrieved from https://escholarship.umassmed.edu/umccts_pubs/243
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Included in
Digestive System Diseases Commons, Epidemiology Commons, Gastroenterology Commons, Hepatology Commons, Infectious Disease Commons, Translational Medical Research Commons, Virus Diseases Commons
Comments
This article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.
The UMass Center for Clinical and Translational Science (UMCCTS), UL1TR001453, helped fund this study.