Impact of Novel Coronavirus Infection on the Course and Prognosis of Cirrhosis

• Published in: Rossiĭskiĭ zhurnal gastroėnterologii, gepatologii, koloproktologii Vol. 33; no. 6; pp. 65 - 80
• Main Authors: Ismailova, A. G., Maslennikov, R. V., Zharkova, M. S., Ivashkin, V. T.
• Format: Journal Article
• Language: English; Russian
• Published: Gastro LLC 04.01.2024
• Subjects: cirrhosis; coronavirus; covid-19; liver; prognosis; sars-cov-2
• ISSN: 1382-4376; 2658-6673
• DOI: 10.22416/1382-4376-2023-33-6-65-80

А im : to investigate the impact of COVID-19 on the course and prognosis of cirrhosis. Materials and methods . This was a cohort study in patients with cirrhosis. We included patients with cirrhosis who underwent a medical examination at our center between September 2019 and March 2020. We determined which of these patients were infected with COVID-19, died of COVID-19, or died of cirrhosis complications within the follow-up period from April 2020 to September 2021. Thereafter, we conducted a second medical examination of these surviving patients with cirrhosis in September to December 2021. Results.  Among the 226 patients included in the study, 57 had COVID-19, among which 19 patients who died of the disease. Acute-on-chronic liver failure (ACLF) developed in 16 (28.1 %) patients with cirrhosis and COVID-19, 13 (81.3 %) of whom died. One of the COVID-19 survivors eventually died of liver decompensation. Twenty patients who did not have COVID-19 died of complications of cirrhosis (ACLF) during the follow-up period. The mortality rate in patients who were infected with COVID-19 was higher than that in patients who were not infected (35.1 % vs. 14.2 %;  p  = 0.001). COVID-19 was an independent risk factor for death in patients with cirrhosis. No liver-specific factors predisposing to COVID-19 infection were identified. A more impaired liver function in the pre-pandemic medical examination was a predisposing factor for death in patients who had COVID-19. Patients who died of COVID-19 had better liver function in the pre-pandemic medical examination than patients without COVID-19 who died of complications of cirrhosis during the follow-up period. The liver-related mortality rate and the incidence of liver decompensation or bleeding from esophageal varices during the follow-up period were not significantly different between patients who recovered from COVID-19 and patients with cirrhosis who did not have COVID-19. Among the analyzed survivors, no significant changes were found in the main indicators of liver function after the follow-up period between patients with and without COVID-19, except for the prothrombin index, which was higher in patients after COVID-19. Conclusion . COVID-19 worsens the prognosis of patients with cirrhosis but does not substantially affect the course of cirrhosis after the recovery from this infection.