Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study.
Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study.
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DOI：
10.1053/j.gastro.2021.07.010
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发表时间：
2021-11
期刊：
影响因子：
29.4
通讯作者：
N3C Consortium
中科院分区：
文献类型：
--
作者：
Ge J;Pletcher MJ;Lai JC;N3C Consortium
在伴有或不伴有肝硬化的慢性肝病（CLD）患者中，现有关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染结局的研究具有有限的普遍性。我们使用了国家COVID队列协作（N3 C），一个统一的电子健康记录数据集640万，描述了CLD和肝硬化患者的SARS-CoV-2结果。我们确定了截至2021年7月1日在N3 C Data Enclave中进行SARS-CoV-2检测的所有CLD伴或不伴肝硬化患者。我们使用生存分析将SARS-CoV-2感染、肝硬化和临床因素与30天死亡率的主要结局相关联。我们分离了220,727例CLD和SARS-CoV-2检测状态的患者：128,864例（58%）为非肝硬化/阴性，29,446例（13%）为非肝硬化/阳性，53,476例（24%）为肝硬化/阴性，8941例（4%）为肝硬化/阳性患者。肝硬化/阴性患者的30天全因死亡率为3.9%，肝硬化/阳性患者的30天全因死亡率为8.9%。与肝硬化/阴性患者相比，肝硬化/阳性患者在30天的校正死亡风险为2.38倍。与非肝硬化/阳性患者相比，肝硬化/阳性患者在30天的校正死亡风险为3.31倍。在分层分析中，在肝硬化患者中，随着年龄的增加，肥胖和合并症（即糖尿病，心力衰竭和肺部疾病），SARS-CoV-2感染与死亡的校正危险增加相关。在这项对大约221，000名全国代表性、多样化和性别平衡的CLD患者的研究中，我们发现肝硬化患者中的SARS-CoV-2感染与2.38倍的死亡风险相关，而感染SARS-CoV-2的CLD患者中的肝硬化与3.31倍的死亡风险相关。这些结果为增加疫苗接种率和进一步研究严重肝病患者对疫苗的免疫反应提供了额外的动力。在这项对220,727名肝病患者的研究中，肝硬化/严重急性呼吸综合征冠状病毒2型阳性患者的30天死亡率为8.9%，严重急性呼吸综合征冠状病毒2型感染与死亡风险相关2.38倍。
In patients with chronic liver disease (CLD) with or without cirrhosis, existing studies on the outcomes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have limited generalizability. We used the National COVID Cohort Collaborative (N3C), a harmonized electronic health record dataset of 6.4 million, to describe SARS-CoV-2 outcomes in patients with CLD and cirrhosis. We identified all patients with CLD with or without cirrhosis who had SARS-CoV-2 testing in the N3C Data Enclave as of July 1, 2021. We used survival analyses to associate SARS-CoV-2 infection, presence of cirrhosis, and clinical factors with the primary outcome of 30-day mortality. We isolated 220,727 patients with CLD and SARS-CoV-2 test status: 128,864 (58%) were noncirrhosis/negative, 29,446 (13%) were noncirrhosis/positive, 53,476 (24%) were cirrhosis/negative, and 8941 (4%) were cirrhosis/positive patients. Thirty-day all-cause mortality rates were 3.9% in cirrhosis/negative and 8.9% in cirrhosis/positive patients. Compared to cirrhosis/negative patients, cirrhosis/positive patients had 2.38 times adjusted hazard of death at 30 days. Compared to noncirrhosis/positive patients, cirrhosis/positive patients had 3.31 times adjusted hazard of death at 30 days. In stratified analyses among patients with cirrhosis with increased age, obesity, and comorbid conditions (ie, diabetes, heart failure, and pulmonary disease), SARS-CoV-2 infection was associated with increased adjusted hazard of death. In this study of approximately 221,000 nationally representative, diverse, and sex-balanced patients with CLD; we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.38 times mortality hazard, and the presence of cirrhosis among patients with CLD infected with SARS-CoV-2 was associated with 3.31 times mortality hazard. These results provide an additional impetus for increasing vaccination uptake and further research regarding immune responses to vaccines in patients with severe liver disease. In this study of 220,727 patients with liver disease, 30-day mortality was 8.9% for cirrhosis/severe acute respiratory syndrome coronavirus 2–positive patients, and severe acute respiratory syndrome coronavirus 2 infection was associated with a 2.38 times hazard of death.
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影响因子：
6.4
作者：
McCashland, TM;Preheim, LC;Gentry-Nielsen, MJ
通讯作者：
Gentry-Nielsen, MJ
影响因子：
39
作者：
Gupta, Shruti;Hayek, Salim S.;Leaf, David E.
通讯作者：
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DOI：
10.1016/s2468-1253(21)00008-x
发表时间：
2021-03
期刊：
The lancet. Gastroenterology & hepatology
影响因子：
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10.1093/jamia/ocaa196
发表时间：
2021-03-01
影响因子：
6.4
作者：
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通讯作者：
Gersing, Ken R.
影响因子：
5.6
作者：
Fedeli, Ugo;Avossa, Francesco;Saugo, Mario
通讯作者：
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