Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study

• Published in: PloS one Vol. 15; no. 12; p. e0243700
• Main Authors: Galiero, Raffaele, Pafundi, Pia Clara, Simeon, Vittorio, Rinaldi, Luca, Perrella, Alessandro, Vetrano, Erica, Caturano, Alfredo, Alfano, Maria, Beccia, Domenico, Nevola, Riccardo, Marfella, Raffaele, Sardu, Celestino, Coppola, Carmine, Scarano, Ferdinando, Maggi, Paolo, De Lucia Sposito, Pellegrino, Vocciante, Laura, Rescigno, Carolina, Sbreglia, Costanza, Fraganza, Fiorentino, Parrella, Roberto, Romano, Annamaria, Calabria, Giosuele, Polverino, Benedetto, Pagano, Antonio, Bologna, Carolina, Amitrano, Maria, Esposito, Vincenzo, Coppola, Nicola, Maturo, Nicola, Adinolfi, Luigi Elio, Chiodini, Paolo, Sasso, Ferdinando Carlo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.12.2020; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Biology and Life Sciences; Chronic Disease; Coma; Comorbidity; Complications and side effects; Consciousness; Control; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - mortality; Diabetes; Epidemics; Female; Forecasts and trends; Health risks; Hospital Mortality; Hospitalization; Hospitals; Humans; Hydrologic data; Hypertension; Infections; Infectious diseases; Intensive care; Internal medicine; Italy - epidemiology; Laboratories; Liver; Liver diseases; Liver Diseases - diagnosis; Liver Diseases - epidemiology; Liver Diseases - mortality; Male; Medical prognosis; Medical statistics; Medicine and Health Sciences; Mental health; Middle Aged; Mortality; Mortality risk; Observational studies; Pandemics; Patients; Preventive medicine; Prognosis; Retrospective Studies; Risk analysis; SARS-CoV-2 - isolation & purification; Sensitivity analysis; Sensitivity enhancement; Severe acute respiratory syndrome coronavirus 2; Software; Ultrasonic imaging; Viral diseases; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243700

Italy has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory. Aim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy). COVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission. Among 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42-4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39-14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21-5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings. Mortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage.