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      COVID‐19 mortality in cirrhosis is determined by cirrhosis‐associated comorbidities and extrahepatic organ failure: Results from the multinational LEOSS registry


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          Background and Objective

          International registries have reported high mortality rates in patients with liver disease and COVID‐19. However, the extent to which comorbidities contribute to excess COVID‐19 mortality in cirrhosis is controversial.


          We used the multinational Lean European Open Survey on SARS‐CoV‐2‐infected patients (LEOSS) to identify patients with cirrhosis documented between March 2020 and March 2021, when the wild‐type and alpha variant were predominant. We compared symptoms, disease progression and mortality after propensity score matching (PSM) for age, sex, obesity, smoking status, and concomitant diseases. Mortality was also compared with that of patients with spontaneous bacterial peritonitis (SBP) without SARS‐CoV‐2 infection, a common bacterial infection and well‐described precipitator of acute‐on‐chronic liver failure.


          Among 7096 patients with SARS‐CoV‐2 infection eligible for analysis, 70 (0.99%) had cirrhosis, and all were hospitalized. Risk factors for severe COVID‐19, such as diabetes, renal disease, and cardiovascular disease were more frequent in patients with cirrhosis. Case fatality rate in patients with cirrhosis was 31.4% with the highest odds of death in patients older than 65 years (43.6% mortality; odds ratio [OR] 4.02; p = 0.018), Child‐Pugh class C (57.1%; OR 4.00; p = 0.026), and failure of two or more organs (81.8%; OR 19.93; p = 0.001). After PSM for demographics and comorbidity, the COVID‐19 case fatality of patients with cirrhosis did not significantly differ from that of matched patients without cirrhosis (28.8% vs. 26.1%; p = 0.644) and was similar to the 28‐day mortality in a comparison group of patients with cirrhosis and SBP (33.3% vs. 31.5%; p = 1.000).


          In immunologically naïve patients with cirrhosis, mortality from wild‐type SARS‐CoV‐2 and the alpha variant is high and is largely determined by cirrhosis‐associated comorbidities and extrahepatic organ failure.


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          Most cited references39

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          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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            Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

            In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
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              OpenSAFELY: factors associated with COVID-19 death in 17 million patients

              COVID-19 has rapidly impacted on mortality worldwide. 1 There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19 related deaths. COVID-19 related death was associated with: being male (hazard ratio 1.59, 95%CI 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared to people with white ethnicity, black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.29-1.69 and 1.45, 1.32-1.58 respectively). We have quantified a range of clinical risk factors for COVID-19 related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.

                Author and article information

                United European Gastroenterol J
                United European Gastroenterol J
                United European Gastroenterology Journal
                John Wiley and Sons Inc. (Hoboken )
                28 April 2022
                May 2022
                : 10
                : 4 ( doiID: 10.1002/ueg2.v10.4 )
                : 409-424
                [ 1 ] Department of Internal Medicine III University Hospital RWTH Aachen, RWTH Aachen University Aachen Germany
                [ 2 ] Emergency Department University Hospital Regensburg Regensburg Germany
                [ 3 ] Department for Infectious Diseases and Infection Control University Hospital Regensburg Germany
                [ 4 ] Department of Internal Medicine II Hospital Passau Passau Germany
                [ 5 ] Department I of Internal Medicine Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany
                [ 6 ] German Centre for Infection Research (DZIF) Partner Site Bonn‐Cologne Cologne Germany
                [ 7 ] Department of Pneumology and Intensive Care Medicine, Internal Medicine V University Hospital RWTH Aachen, RWTH Aachen University Aachen Germany
                [ 8 ] Clinic for Intensive Care and Emergency Medicine Hospital Ernst von Bergmann Potsdam Germany
                [ 9 ] Department of Internal Medicine II, Hematology and Medical Oncology University Hospital Jena Jena Germany
                [ 10 ] Department II of Internal Medicine, Hematology/Oncology Goethe University, Frankfurt Frankfurt Am Main Germany
                [ 11 ] Department of Infectious Diseases and Infection Control Ingolstadt Hospital Ingolstadt Germany
                [ 12 ] Department of Internal Medicine Infectious Diseases University Hospital Frankfurt Goethe University Frankfurt Frankfurt am Main Germany
                [ 13 ] Department of Internal Medicine IV Jena University Hospital Jena Germany
                [ 14 ] Johannes Wesling Klinikum Minden Oncology, Haemostaseology and Palliative Care Johannes Wesling Klinikum University of Bochum Minden Germany
                [ 15 ] Department of Neurology St. Josef‐Hospital Bochum Ruhr University Bochum Bochum Germany
                [ 16 ] Department of Internal Medicine II Infectious Diseases University Hospital Wuerzburg Wuerzburg Germany
                [ 17 ] Department of Internal Medicine II School of Medicine Technical University of Munich University Hospital Rechts der Isar Munich Germany
                [ 18 ] Department of Internal Medicine I UKB University Hospital Bonn Bonn Germany
                Author notes
                [*] [* ] Correspondence

                Tony Bruns, Department of Internal Medicine III, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, 52074, Germany.

                Email: tbruns@ 123456ukaachen.de

                © 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Figures: 3, Tables: 6, Pages: 16, Words: 9586
                Funded by: Deutsche Forschungsgemeinschaft , doi 10.13039/501100001659;
                Award ID: SFB1382 Project ID 403224013/B07
                Funded by: Willy Robert Pitzer Foundation
                Funded by: Deutsches Zentrum für Infektionsforschung , doi 10.13039/100009139;
                Original Article
                Custom metadata
                May 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.5 mode:remove_FC converted:13.05.2022

                acld,chronic liver disease,cirrhosis,covid‐19,sars‐cov‐2,sbp


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