High rates of 30-day mortality in patients with cirrhosis and COVID-19
High rates of 30-day mortality in patients with cirrhosis and COVID-19
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DOI：
10.1016/j.jhep.2020.06.001
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发表时间：
2020-11-01
影响因子：
25.7
通讯作者：
Lampertico, Pietro
中科院分区：
文献类型：
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作者：
Iavarone, Massimo;D'Ambrosio, Roberta;Lampertico, Pietro
背景与目的：2019冠状病毒病（COVID-19）对健康个体和合并症患者构成重大健康威胁，但其对肝硬化患者的影响目前尚不清楚。本研究旨在评估COVID-19对肝硬化患者临床结局的影响。方法：在这项多中心回顾性研究中，纳入了2020年3月1日至31日期间肝硬化和确诊的严重急性呼吸综合征冠状病毒-2 （SARS-CoV-2）感染患者。通过查阅病历获得诊断时和最后一次门诊时的临床和生化资料。结果：纳入了50例肝硬化并确诊为SARS-CoV-2感染的患者（年龄67岁，70%为男性，38%为病毒相关，52%为既往代偿性肝硬化）。在诊断时，64%的患者出现发烧，42%的患者出现呼吸短促/呼吸急促，22%的患者出现脑病，96%的患者需要住院治疗，如果已经住院，则需要延长住院时间。71%的患者需要呼吸支持，52%接受抗病毒药物治疗，80%接受肝素治疗。与最新数据相比，COVID-19诊断时血清白蛋白显著降低，胆红素、肌酐和凝血酶原时间显著增加。终末期肝病模型（MELD）评分为>-15的患者比例从13%增加到26% (p = 0.037)，发生急性慢性肝衰竭和新发急性肝损伤的患者分别为14例（28%）和10例。17名患者在COVID-19诊断后的中位数10（4-13）天后死亡，30天死亡率为34%。肺和肝疾病的严重程度（根据cliff - c、cliff - of和MELD评分）独立预测死亡率。在肝硬化患者中，COVID-19患者的死亡率明显高于因细菌感染住院的患者。结论：COVID-19与肝硬化患者肝功能恶化和死亡率升高有关。摘要：2019冠状病毒病（COVID-19）对健康个体和合并症患者构成重大健康威胁。在此，我们评估了其对肝硬化患者的影响。COVID-19感染与肝硬化患者肝功能恶化和死亡率升高有关。(C) 2020欧洲肝脏研究协会。Elsevier B.V.版权所有。
Background & Aims: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis.Methods: In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records.Results: Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virusrelated, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/ polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score >-15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections.Conclusion: COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis.Lay summary: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.