Post COVID Condition and Long-Term COVID-19 Impact on Hepatic Decompensation and Survival in Cirrhosis: A Propensity Matched Observational Study

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open Pub Date : 2025-03-24 DOI:10.1002/jgh3.70142

Prerna Sharma, Madhumita Premkumar, Rashmi Ranjan Guru, Anchal Sandhu, Kamal Kajal, Arka De, Sahaj Rathi, Nipun Verma, Sunil Taneja, Virendra Singh, Ajay Kumar Duseja

{"title":"Post COVID Condition and Long-Term COVID-19 Impact on Hepatic Decompensation and Survival in Cirrhosis: A Propensity Matched Observational Study","authors":"Prerna Sharma, Madhumita Premkumar, Rashmi Ranjan Guru, Anchal Sandhu, Kamal Kajal, Arka De, Sahaj Rathi, Nipun Verma, Sunil Taneja, Virendra Singh, Ajay Kumar Duseja","doi":"10.1002/jgh3.70142","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>Patients with cirrhosis are susceptible to decompensation events, including ascites, variceal bleeding (VB), hepatic encephalopathy, or death after COVID-19 infection. Patients may experience post-COVID condition (PCC) with multisystem involvement that persists for at least 2 months.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Hospitalized patients with cirrhosis and COVID-19 between January 2021 and January 2023 were assessed for decompensation events and mortality and compared to a propensity-matched cohort of cirrhosis and non-COVID-19 sepsis. Both groups were followed for outcomes over 1 year.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 252 patients with Cirrhosis+ COVID-19 (73% men, aged 48.9 ± 13.7 years, 31%-diabetes, 44%-hypertension, 35%-alcohol-associated, 34.5%-metabolic dysfunction-associated steatotic liver disease; MASLD), 72 (28.6%) died in hospital and 180 (71.4%) recovered, similar to Cirrhosis+ non-COVID-sepsis (58/214, 27.1%). Finally,60 (33.3%) met criteria for PCC, 19 (10.5%) had no post COVID-19 sequelae and 101 (56.1%) patients died (<i>N</i> = 45) or were lost to follow up (<i>N</i> = 56). Late Mortality was higher in Cirrhosis+ COVID-19 than non-COVID-sepsis (56.1% vs. 35.3%, <i>p</i> = 0.026). Patients with PCC were aged 47.6 years, 63.3%-men, Charlson Comorbidity Index > 4 (51.7%), 45%-diabetes, 56.7%-hypertension, with 33.3%, 23.3%, and 43.3% in Child-Turcotte-Pugh class A, B and C, respectively. PCC symptoms included persistent dyspnea (34, 43%), cognitive impairment (20, 25.3%), and anxiety (47, 59.4%). On multivariable analysis, predictors of the development of PCC were baseline MELDNa (HR 1.12, 95% CI: 1.05–1.17, <i>p</i> < 0.001) and age (HR 0.9, 95% CI: 0.91–0.99, <i>p</i> = 0.012). Predictors of mortality following COVID-19 recovery were MELDNa (HR 1.03, 95% CI: 1.01–1.05, <i>p</i> = 0.008), age (HR 1.2, 95% CI: 1.1–1.5, <i>p</i> = 0.002) and hypertension (HR 1.63, 95% CI: 1.07–2.49, <i>p</i> = 0.025).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>COVID-19 is associated with long-term mortality in cirrhosis even after recovery from respiratory infection. Long COVID is seen in a third of COVID-19 survivors in patients with cirrhosis.</p>\n </section>\n </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 3","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70142","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JGH Open","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jgh3.70142","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Aims

Patients with cirrhosis are susceptible to decompensation events, including ascites, variceal bleeding (VB), hepatic encephalopathy, or death after COVID-19 infection. Patients may experience post-COVID condition (PCC) with multisystem involvement that persists for at least 2 months.

Methods

Hospitalized patients with cirrhosis and COVID-19 between January 2021 and January 2023 were assessed for decompensation events and mortality and compared to a propensity-matched cohort of cirrhosis and non-COVID-19 sepsis. Both groups were followed for outcomes over 1 year.

Results

Of 252 patients with Cirrhosis+ COVID-19 (73% men, aged 48.9 ± 13.7 years, 31%-diabetes, 44%-hypertension, 35%-alcohol-associated, 34.5%-metabolic dysfunction-associated steatotic liver disease; MASLD), 72 (28.6%) died in hospital and 180 (71.4%) recovered, similar to Cirrhosis+ non-COVID-sepsis (58/214, 27.1%). Finally,60 (33.3%) met criteria for PCC, 19 (10.5%) had no post COVID-19 sequelae and 101 (56.1%) patients died (N = 45) or were lost to follow up (N = 56). Late Mortality was higher in Cirrhosis+ COVID-19 than non-COVID-sepsis (56.1% vs. 35.3%, p = 0.026). Patients with PCC were aged 47.6 years, 63.3%-men, Charlson Comorbidity Index > 4 (51.7%), 45%-diabetes, 56.7%-hypertension, with 33.3%, 23.3%, and 43.3% in Child-Turcotte-Pugh class A, B and C, respectively. PCC symptoms included persistent dyspnea (34, 43%), cognitive impairment (20, 25.3%), and anxiety (47, 59.4%). On multivariable analysis, predictors of the development of PCC were baseline MELDNa (HR 1.12, 95% CI: 1.05–1.17, p < 0.001) and age (HR 0.9, 95% CI: 0.91–0.99, p = 0.012). Predictors of mortality following COVID-19 recovery were MELDNa (HR 1.03, 95% CI: 1.01–1.05, p = 0.008), age (HR 1.2, 95% CI: 1.1–1.5, p = 0.002) and hypertension (HR 1.63, 95% CI: 1.07–2.49, p = 0.025).

Conclusion

COVID-19 is associated with long-term mortality in cirrhosis even after recovery from respiratory infection. Long COVID is seen in a third of COVID-19 survivors in patients with cirrhosis.

Abstract Image

查看原文本刊更多论文

目的肝硬化患者感染 COVID-19 后容易出现失代偿事件，包括腹水、静脉曲张出血 (VB)、肝性脑病或死亡。患者可能会出现持续至少 2 个月的多系统受累的 COVID 后症状（PCC）。方法评估 2021 年 1 月至 2023 年 1 月期间肝硬化合并 COVID-19 的住院患者的失代偿事件和死亡率，并与肝硬化和非 COVID-19 败血症的倾向匹配队列进行比较。两组患者均接受了为期一年的随访。结果在252名肝硬化+COVID-19患者（73%为男性，年龄为48.9 ± 13.7岁，31%为糖尿病，44%为高血压，35%为酒精相关性，34.5%为代谢功能障碍相关性脂肪肝；MASLD）中，72人（28.6%）在医院死亡，180人（71.4%）痊愈，与肝硬化+非COVID-19败血症（58/214，27.1%）相似。最后，60 例（33.3%）符合 PCC 标准，19 例（10.5%）没有 COVID-19 后遗症，101 例（56.1%）患者死亡（45 例）或失去随访机会（56 例）。肝硬化+COVID-19患者的晚期死亡率高于非COVID-19患者（56.1% vs. 35.3%，P = 0.026）。PCC患者年龄为47.6岁，63.3%为男性，Charlson合并症指数为4（51.7%），45%为糖尿病，56.7%为高血压，Child-Turcotte-Pugh分级为A、B和C的患者分别占33.3%、23.3%和43.3%。PCC 症状包括持续性呼吸困难（34，43%）、认知障碍（20，25.3%）和焦虑（47，59.4%）。经多变量分析，预测 PCC 发生的因素是基线 MELDNa（HR 1.12，95% CI：1.05-1.17，p <0.001）和年龄（HR 0.9，95% CI：0.91-0.99，p = 0.012）。COVID-19恢复后的死亡率预测因素为MELDNa（HR 1.03，95% CI：1.01-1.05，p = 0.008）、年龄（HR 1.2，95% CI：1.1-1.5，p = 0.002）和高血压（HR 1.63，95% CI：1.07-2.49，p = 0.025）。结论 COVID-19 与肝硬化患者的长期死亡率有关，即使在呼吸道感染恢复后也是如此。肝硬化患者中三分之一的 COVID-19 幸存者会出现长期 COVID。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊