Effect of COVID-19 on patients with liver cirrhosis
Objective To investigate the effect of corona virus disease 2019(COVID-19)on the progression and prognosis of patients with liver cirrhosis.Methods A total of 115 patients with cirrhosis admitted to the Gansu Provincial People's Hospital from October 31,2022 to March 10,2023 were collected and divided into cirrhosis with COVID-19 group(n=31)and simple cirrhosis group(n=84).The biochemical,coagulation,blood routine and other related indexes and complications related to liver cirrhosis decompensation were compared between the two groups,and the liver reserve function and extrahepatic comorbidities of the two groups were evaluated by Child-Turcotte-Pugh(CTP)grade,model for end-stage liver disease-Na(MELD-Na)score,Charlson comorbidity index(CCI)and chronic liver failure-sequential organ failure assessment(CLIF-SOFA)score.COX regression was used to analyze factors associated with 30-day death in patients with cirrhosis and COVID-19.Results Compared with the simple cirrhosis group,patients in cirrhosis combined with COVID-19 group had higher aspartate aminotransferase(AST)[48.00(31.00-104.00)U/L vs.35.50(24.00-55.75)U/L],lower albumin(ALB)[(27.26±5.84)g/L vs.(31.67±5.81)g/L],and higher international normalized ratio(INR)[1.56(1.20-1.83)vs.1.26(1.14-1.47)],with statistically significant differences(U/t=1 622.00,3.56,1 758.50,all P＜0.05);Patients in cirrhosis combined with COVID-19 group had a higher incidence of spontaneous peritonitis(19.35％vs.2.38％),and inflammatory markers such as the percentage of neutrophils[(70.02±15.19)％vs.(62.21±13.00)％]and interleukin-6(IL-6)[67.64(28.28-167.60)μg/mLvs.30.25(8.85-59.19)μg/mL]were significantly higher,with statistically significant differences(x2/U/t=10.08,-2.73,254.50;all P＜0.05);Patients with cirrhosis combined with COVID-19 group had a higher proportion of CTP Class C(61.23％vs.28.57％)and higher CLIF-SOFA score[6(4-9)score vs.4(2-5)score],MELD-Na score[(18.42±8.01)score vs.(14.60±6.21)score],CCI[7(6-9)vs.6(5-7)]and mortality rate(25.81％vs.4.76％),with statistically significant differences(x2/U/t=10.36,1 095.50,-2.42,1 855.50,10.73;all P＜0.05).COX regression analysis showed that CCI(HR=2.77,95％CI:1.09-7.03,P=0.03)and CLIF-SOFA score(HR=4.24,95％CI:1.33-13.50,P=0.01)could be used as predictors of mortality in patients with cirrhosis and COVID-19.Conclusion COVID-19 could cause deterioration of liver function and progression of extrahepatic organ failure in patients with cirrhosis,increasing the risk of death at 30 days,and respiratory failure was the main cause of death.
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