慢性肝病患者SARS-CoV-2感染后的结果：一项国际注册研究

StephenW

Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study

    Thomas Marjot †
    Andrew M. Moon †
    Jonathan A. Cook
    Eleanor Barnes †
    Alfred S. Barritt IV †
    Gwilym J. Webb †
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Open AccessPublished:October 06, 2020DOI:https://doi.org/10.1016/j.jhep.2020.09.024


Highlights

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    Patients with cirrhosis experience high rates of hepatic decompensation and death following SARS-CoV-2 infection.
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    Mortality increased in stepwise fashion according to Child-Pugh class.
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    Other risk factors for death included advancing age and alcohol-related liver disease.
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    Mortality risk was higher in patients with advanced cirrhosis than propensity-score-matched controls without liver disease.
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    The majority of deaths in patients with cirrhosis were from COVID-19-related lung disease.

Background & Aims
Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined.
Methods
Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network.
Results
Mortality was 32% in patients with cirrhosis compared to 8% in those without (p <0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01–1.04), Child-Pugh A (OR 1.90; 1.03–3.52), B (OR 4.14; 2.4–7.65), or C (OR 9.32; 4.80–18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03–3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%–31.3%]) and C (+38.1% [27.1%–49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure.
Conclusions
In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic.
Lay summary
This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease.

StephenW

慢性肝病患者SARS-CoV-2感染后的结果：一项国际注册研究

    托马斯·马约特†
    安德鲁·穆恩（†）
    乔纳森·库克
    埃莉诺·巴恩斯（Eleanor Barnes）†
    阿尔弗雷德·S·巴里特四世†
    Gwilym J.Webb†
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开放获取发布时间：2020年10月6日DOI：https：//doi.org/10.1016/j.jhep.2020.09.024


强调

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    肝硬化患者发生SARS-CoV-2感染后肝失代偿和死亡的发生率很高。
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    根据Child-Pugh班级，死亡率以逐步的方式增加。
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    其他死亡危险因素包括年龄增长和酒精相关的肝病。
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    晚期肝硬化患者的死亡率风险高于无肝病倾向得分对照。
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    肝硬化患者的死亡大多数是与COVID-19相关的肺部疾病。

背景与目标
慢性肝病（CLD）和肝硬化与免疫功能异常有关，导致人们担心受感染的患者可能会在SARS-CoV-2感染后有不良后果的风险。我们的目的是确定COVID-19对目前尚不明确的已有肝病患者的影响。
方法
在2020年3月25日至7月8日之间，由两个国际注册机构收集了745例CLD和SARS-CoV-2患者（包括386例和359例无肝硬化）的数据，并将其与非CLD的SARS-CoV-2患者的数据进行了比较来自英国医院网络。
结果
肝硬化患者的死亡率为32％，而无肝硬化的患者为8％（p <0.001）。肝硬化患者的死亡率根据Child-Pugh类别增加（A [19％]，B [35％]，C [51％]），并且死亡的主要原因是呼吸衰竭（71％）。调整基线特征后，与总CLD队列死亡相关的因素是年龄（赔率[OR] 1.02； 1.01-1.04），Child-Pugh A（OR 1.90； 1.03-3.52），B（OR 4.14； 2.4- 7.65）或C（OR 9.32; 4.80-18.08）肝硬化和酒精相关性肝病（OR 1.79; 1.03-3.13）。与没有CLD的患者（n = 620）相比，倾向得分匹配分析显示，Child-Pugh B（+ 20.0％[8.8％–31.3％]）和C（C ++（+ 38.1％[27.1％） –49.2％]）肝硬化。肝硬化患者中有46％发生急性肝失代偿，其中21％没有呼吸道症状。肝功能不全者中有一半患有慢性慢性肝功能衰竭。
结论
在迄今为止最大的此类队列中，我们证明基线肝病阶段和酒精相关肝病是COVID-19死亡的独立危险因素。这些数据对于COVID-19大流行期间全球CLD患者的风险分层具有重要意义。
放置摘要
这项国际注册研究表明，肝硬化患者死于COVID-19的风险增加。在肝硬化晚期和酒精相关性肝病患者中，COVID-19的死亡率特别高。

StephenW

https://www.journal-of-hepatolog ... 8278(20)33667-9/pdf

lancas

有慢性病的人再患上新冠都不是什么好事