Journal Article

Clinical outcomes of COVID-19 in patients with liver cirrhosis - a propensity-matched analysis from a multicentric Brazilian cohort

Guimarães Júnior, Milton Henriques, Aranha, Fernando Graça, da Cunha, Pedro Ferrari Sales, Carneiro, Marcelo, Pires, Magda Carvalho, Menezes, Luanna Silva Monteiro, Costa, Flávia Carvalho Cardoso, Valle, Lucas Rocha, Francisco, Saionara Cristina, Ferreira, Maria Angélica Pires, de Carvalho, Rafael Lima Rodrigues, Marcolino, Milena Soriano, Silveira, Daniel Vitório, de Abreu Ferrari, Teresa Cristina

2025

Overview

Background Cirrhosis has been pointed out as a clinical entity that leads to worse clinical prognosis in COVID-19 patients. However, this concept is controversial in the literature. We aimed to evaluate clinical outcomes by comparing patients with cirrhosis to those without cirrhosis in a Brazilian cohort. Methods Data from 20,164 COVID-19 inpatients were collected from 41 hospitals in Brazil between March to September 2020 and March 2021 to August 2022. We compared 117 patients with cirrhosis to 632 matched controls. A propensity score model was used to adjust for potential confounding variables, incorporating some predictors: age, sex at birth, number of comorbidities, hospital of admission, whether it was an in-hospital clinical manifestation of COVID-19, and admission year. Closeness was defined as being within 0.16 standard deviations of the logit of the propensity score. Results The median age was 61 (IQR 50–70) years old, and 63.4% were men. There were no significant differences in the self-reported symptoms. Patients with cirrhosis had lower median hemoglobin levels (10.8 vs. 13.1 g/dl), lower platelets (127,000 vs. 200,000 cells/mm3), and leukocyte counts, as well as lower median C-reactive protein (63.0 vs. 76.0 p  = 0.044) when compared to controls. They also had higher mortality compared to matched controls (51.3% vs. 21.7%, p  < 0.001). They also had higher frequencies of admission in an intensive care unit (51.3% vs. 38.0%, p  = 0.007), invasive mechanical ventilation (43.9% vs. 26.6%, p  < 0.001), dialysis (17.9% vs. 11.1%, p  = 0.038), septic shock (23.9% vs. 14.9%; p  = 0.015) and institution of palliative care (19.7% vs. 7.4%; p  < 0.001). Conclusions This study has shown that COVID-19 inpatients with cirrhosis had significantly higher incidence of severe outcomes, as well as higher frequency of institution of palliative care when compared to matched controls. Our findings underscore the need for these patients to receive particular attention from healthcare teams and allocated resources.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Aged / Application of advanced statistical methods in infectious diseases / Brazil - epidemiology / C-reactive protein / Cardiac arrhythmia / Cardiovascular disease / Care and treatment / Chronic obstructive pulmonary disease / Cirrhosis / Cohort Studies / Comorbidity / COVID-19 / COVID-19 - complications / COVID-19 - epidemiology / COVID-19 - mortality / COVID-19 - therapy / Demographics / Diabetes / Diagnosis / Dialysis / Female / Heart failure / Hemoglobin / Hospital patients / Hospitalization - statistics & numerical data / Hospitals / Humans / Hypertension / Infectious Diseases / Internal Medicine / Kidney diseases / Laboratories / Liver cirrhosis / Liver Cirrhosis - complications / Liver Cirrhosis - epidemiology / Liver Cirrhosis - mortality / Liver diseases / Male / Mechanical ventilation / Medical Microbiology / Medical records / Medicine / Medicine & Public Health / Middle Aged / Mortality / Nosocomial infections / Palliation / Palliative treatment / Pandemics / Parasitology / Patient Outcome Assessment / Patients / Prevention / Prognosis / Propensity Score / Research ethics / Risk factors / SARS-CoV-2 / Septic shock / Severe acute respiratory syndrome coronavirus 2 / Software / Statistical analysis / Tropical Medicine / Variables