COVID-19 in patients with pre-existing chronic liver disease – predictors of outcomes

Table 1 Studies showing clinical outcomes of chronic liver disease in coronavirus disease 2019 and associated risk factors

Ref.	Type	Clinical outcomes	Predictors of outcomes
Iavarone et al[53]	Multicentric retrospective study of 50 cirrhotics	ACLF and de novo acute liver injury: 28%; 30-d mortality: 34%	Predictors of mortality: CLIF-OF (HR: 1.426); Moderate/severe respiratory failure (HR: 1.608)
Marjot et al[22]	Retrospective data from United Kingdom hospital network including 745 patients with CLD (386 with and 359 without cirrhosis)	Acute hepatic decompensation: 46%; ACLF: 50%; Mortality in cirrhosis, ACLF, and non-cirrhotics: 32%, 65%, and 8%	Predictors of mortality: ALD (OR: 1.79); Child-Pugh class: Child-Pugh A +2.0%, Child-Pugh B +20.0%, Child-Pugh C +38.1%. Predictors of decompensation: Child-Pugh class
Ge et al[16]	Data from the National COVID Cohort Collaborative (N3C) dataset of 6.4 million cases	3.31 times adjusted hazard of death in cirrhotics at 30 d than non-cirrhotics	Predictors of 30-d mortality: Age (aHR: 1.05 per year); Hispanic ethnicity (aHR: 1.20); Chronic hepatitis C (aHR: 1.27); ALD (aHR: 1.40); Modified CCI (aHR: 1.07 per point)
Elhence et al[24]	Retrospective analysis of 221 cirrhosis patients	Compensated cirrhosis: 8.1%; Acute decompensation: 62.9%; ACLF: 29.0%; MODS: 55.6%; Type 1 respiratory failure: 20.0%; Sudden cardiac arrest: 6.7%; GI bleeding: 3.3%	Predictors of mortality: Higher TLC [HR: 1.054]; Elevated creatinine [HR: 1.184]; MELD score [HR: 1.038]; Alkaline phosphatase [HR: 1.003]; COVID-19 severity [HR: 2.573]; ACLF on presentation (HR: 2.573)
Xiao et al[52]	Medical records collected from 23 Chinese hospitals	Decompensated cirrhosis: 57.5%; Mortality: 28.9%	Factors associated with mortality: Child-Pugh class (OR: 5.71); CURB65 (OR: 5.88)
Grgurevic et al[48]	4014 patients	Four times higher risk of 30-d mortality in cirrhosis	Predictor of 30-d mortality: Cirrhosis (HR: 2.95)
Mendizabal et al[17]	Prospective cohort of 96 cirrhosis patients	Mortality in cirrhotic: 47% vs 16% in non-cirrhotics; Acute decompensation: 61.4%; ACLF: 55.2%	Factors associated with mortality: Age > 65 yr (OR: 7.2); Male gender (OR: 1.8); BMI > 30 (OR: 1.7); Cirrhosis (OR: 3.1)
Kim et al[18]	Multicentre observational cohort study in 21 institutes in United States with 867 CLD cases (227 with cirrhosis)	Mortality: 25%; Hepatic decompensation: 7.7%; Hepatic encephalopathy: 34.3%; Ascites: 16.4%; Variceal bleed: 10.4%	Predictors of all-cause mortality: ALD (HR: 2.42); Hepatic decompensation at baseline (HR: 2.91); HCC (HR: 3.31); Increasing age (HR:1.44 per 10 yr); Diabetes (HR: 1.59); Hypertension (HR:1.77); COPD (HR:1.77); Current smoking (HR: 2.48)
Sarin et al[37]	Retrospective data from 13 Asian countries with228 patients [185 CLD without cirrhosis and 43 with cirrhosis]	ACLF: 11.6%; Acute decompensation: 9%; Mortality rate: 43% among decompensated cirrhotics	Predictors of sever liver injury: In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR: 2.1 (1.1-3.7)]; In cirrhotics, obesity [64.3% vs 17.2%, OR: 8.1 (1.9-38.8). Predictor of mortality: CTP score of 9 or more at presentation [AUROC 0.94, HR:19.2]
Xiang et al[54]	Retrospective cohort study of 267 patients	Severe COVID-19: 15%; High-flow oxygen support: 14%; Mechanical ventilator support: 4%; Death: 1	Predictor of severity: FIB-4 > 3.25

ACLF: Acute-on-chronic liver failure; ALD: Alcohol related liver disease; AUROC: Area under the receiver operator curve; BMI: Body mass index; COVID: Coronavirus disease; CLD: Chronic liver disease; CCI: Charlson’s comorbidity index; CLIF OF: Chronic liver failure consortium organ failure; CLIF-C: Chronic liver failure consortium; COPD: Chronic obstructive pulmonary disease; CTP: Child-Turcotte-Pugh score; FIB-4: Fibrosis 4; HCC: Hepatocellular carcinoma; MELD Na: Model for end stage liver disease sodium score; MODS: Multiorgan dysfunction syndrome; NACSELD: North American Consortium for the Study of End-Stage Liver Disease.