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Hospital Rate Falls More Than 12%
With COVID Vax for Cirrhosis Patients
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AASLD, The Liver Meeting, November 12-15, 2021
Mark Mascolini
Two COVID vaccine doses cut the hospital admission rate 12% in people with cirrhosis compared with unvaccinated cirrhotics, according to a nationwide analysis in Chile [1]. COVID vaccination also trimmed hospitalization rates in people with heart failure, diabetes, hypertension, and asthma, but the protective benefit was greater in people with cirrhosis.
COVID-19 affects the liver more than any organ except the lung, according to researchers at Santiago's Pontificia Universidad Catolica de Chile School of Medicine who conducted this study. COVID-related mortality is substantially higher in people with than without cirrhosis and is directly related to cirrhosis severity. COVID-19 spurs hepatic decompensation in 46% of people with cirrhosis. Most COVID vaccine studies exclude people with cirrhosis, whose weakened immune response can compromise vaccine efficacy.
This research team set out to figure the hospitalization rate due to COVID-19 and to gauge the impact of vaccination against SARS-CoV-2 hospital admission in people with cirrhosis. By one analysis, the researchers noted, 81% of people in Chile had received at least one dose of a COVID vaccine and 72% had two shots, behind only the United Arab Emirates and Portugal, and ahead of Canada, Denmark, China, Italy, Brazil, Germany, the United States, and all other countries in the analysis.
The investigators gathered data from the national SARS-CoV-2 surveillance program of the Chilean Ministry of Health, counting confirmed and probable COVID-19 cases from March 3, 2020 through May 30, 2021. Diagnosis relied on real-time polymerase chain reaction (qPCR) performed by the Chilean Institute of Public Health and certified labs. The researchers created regression discontinuity models to assess relationships between COVID vaccination and hospital admission rates according to comorbidities recorded in inpatients. The response analysis had two cutoffs-after the first vaccination dose and 14 days after the second dose.
When the research team conducted this study, Chile had 1,648,680 COVID-19 cases for an incidence of 8472.9 cases per 100,000 people. Median age of infected people stood at 39 years, 50.2% were female, 7.7% got admitted to the hospital, and 0.1% (2050 people) had cirrhosis. Among those with cirrhosis, 42.9% required hospital admission, more than 5.5 times the general population rate of 7.7%.
In the overall study population, 50.1% had been vaccinated, and 75.5% of those vaccinated had two shots. All COVID vaccines being used in Chile required two doses. The most-used vaccine was China's CoronaVac (79.4%), followed by the Pfizer/BioNTech vaccine (18.7%), and the AstraZeneca vaccine (1.9%).
After the first COVID vaccine dose, absolute reduction in hospital admission rate stood at about 5% in people with cirrhosis (compared with unvaccinated cirrhotics) and 5% in those with chronic kidney disease (compared with their unvaccinated counterparts). Reduction rates were about 3% in people with heart failure or hypertension and about 1% in those with asthma.
Fourteen days after the second vaccine dose, absolute reduction in hospital admission rate (compared with no vaccination) reached more than 12% in people with cirrhosis (-12.69, 95% confidence interval -21.71 to -3.68, P < 0.01). People with other comorbidities considered (heart failure, diabetes mellitus, hypertension, asthma, in that order) also had significant drops in hospitalization rate 14 days after the second dose, but these absolute reductions were not as great as the response seen in people with cirrhosis.
The researchers believe their findings support making people with chronic liver disease a COVID vaccination priority group when resources are limited.
Reference
1. Díaz Piga LA, Fuentes-Lopez E, Lazo M, Kamath PS, Arrese M, Arab JP. Vaccination against COVID-19 decreases hospitalizations in patients with cirrhosis: results from a nationwide analysis. The Liver Meeting, November 12-15, 2021. Parallel session 4: COVID-19 Clinical.
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