Predictors of Outcomes of COVID-19 in Patients With Chronic Liver Disease: US Multi-center Study Article

Full Text via DOI: 10.1016/j.cgh.2020.09.027 Web of Science: 000664753500028
Highly Cited Paper

Cited authors

  • Kim D, Adeniji N, Latt N, Kumar S, Bloom PP, Aby SE, Perumalswami P, Roytman M, Li MC, Vogel SA, Catana MA, Wegermann K, Carr MR, Aloman C, Chen LV, Rabiee A, Sadowski B, Nguyen V, Dunn W, Chavin DK, Zhou KL, Lizaola-Mayo B, Moghe A, Debes J, Lee TH, Branch DA, Viveiros K, Chan WL, Chascsa MD, Kwo P, Dhanasekaran R


  • BACKGROUND & AIMS: Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19).METHODS: We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD.RESULTS: Of the 978 patients in our cohort, 867 patients (mean age 56.9 +/- 14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19.CONCLUSIONS: The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19.


Publication date

  • 2021

International Standard Serial Number (ISSN)

  • 1542-3565

Number of pages

  • 30

Start page

  • 1469

End page

  • +


  • 19


  • 7