Dr Thomas Marjot of the University of Oxford presenting to EASL 2020.
People with advanced liver cirrhosis are more likely to
develop severe COVID-19 complications and to die from it, but those who have
received liver transplants do not appear to be at greater risk, researchers
reported at the conference.
Dr Thomas Marjot of the University of Oxford and colleagues analysed data
from two international registries of people with liver disease and COVID-19.
The SECURE-Cirrhosis registry
collects case reports from North and South America and parts of Asia, while
EASL's COVID-HEP registry includes
reports from the rest of the world. Dr Marjot reported on outcomes in 745
patients with chronic liver disease and COVID-19, of whom 386 had progressed to
cirrhosis, registered up to 8 July 2020.
The analysis compared people without cirrhosis and those with three levels
of cirrhosis severity: Child-Pugh (CP) class A, B and C, with C being most
severe.
For each higher level of liver disease severity, the risk of adverse
outcomes, including intensive care unit admission, mechanical ventilation and
death, increased in a stepwise fashion.
Most people without cirrhosis survived, with mortality rates of 8% for those
who were hospitalised and 21% for those on ventilators. Among those with CP
class A, mortality rates were 22% once hospitalised and 52% once put on a
ventilator. Among those with CP class B, the respective rates were 39% and 74%.
Among those with CP class C, more than half of hospitalised patients (54%), and
most of those on ventilators (90%) died.
The most common cause of death for people with cirrhosis and COVID-19 was
respiratory disease (71%), far exceeding liver-related deaths (19%) and cardiac
deaths (5%). Nearly half of people with cirrhosis (46%) experienced liver
decompensation, but even in this subgroup lung disease led to higher mortality
than liver-related complications (64% versus 24%, respectively).
Prof. Marina Berenguer Haym of the University of Valencia in Spain presented
an analysis of outcomes among liver transplant recipients with COVID-19 in the
same two registries. The findings were published in The Lancet
Gastroenterology and Hepatology.
This analysis included 181 liver transplant recipients with COVID-19 in 18
countries. The control group included 627 COVID-19 patients who had not
received transplants.
Transplant recipients and non-transplant patients with COVID-19 were hospitalised
at similar rates (82% vs 76%, respectively). However, the transplant patients
were more likely to be admitted to intensive care (28% vs 8%) and to be put on
ventilators (20% vs 5%). Nonetheless, the transplant group had a somewhat lower
mortality rate than those who did not receive transplants (19% vs 27%).
"We should be reassured that clinicians and health policy makers should
be aware liver transplantation does not confer major additional susceptibility
to adverse outcomes," Prof. Thomas Berg of the University of Leipzig in
Germany said at a press briefing in advance of the conference. He suggested
that a bigger concern is that people with liver disease may avoid medical care
due to fear of COVID-19, which could lead to subsequent waves of advanced liver
complications in the future.
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