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COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States
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Based on analyses of a nation-wide EHR database in the US we show that patients with CLD, (non-alcoholic cirrhosis, chronic hepatitis C, alcoholic liver damage, alcoholic liver cirrhosis and chronic hepatitis B) especially those who had recent medical encounter for CLD, were at significantly increased risk for COVID-19 acquisition compared with patients without CLD. African Americans with CLD were twice more likely to get COVID-19 than Caucasians with CLD. COVID-19 patients with CLD had higher rates of hospitalization and death than COVID-19 negative patients with CLD and COVID-19 patients without CLD.
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Dec 2020 - QuanQiu Wanga, Pamela B. Davisb, Rong Xua,*
a Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, 2103 Cornell Rd, Cleveland 44106, OH, USA b Center for Clinical Investigation, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30432-6/fulltext
Abstract
Background
Scientific evidence is lacking regarding the risk of patients with chronic liver disease (CLD) for COVID-19, and how these risks are affected by age, gender and race.
Methods
We performed a case-control study of electronic health records of 62.2 million patients (age >18 years) in the US up to October 1st, 2020, including 1,034,270 patients with CLD, 16,530 with COVID-19, and 820 with both COVID-19 and CLD. We assessed the risk, disparities, and outcomes of COVID-19 in patients with six major CLDs.
Findings
Patients with a recent medical encounter for CLD were at significantly increased risk for COVID-19 compared with patients without CLD, with the strongest effect in patients with chronic non-alcoholic liver disease [adjusted odd ratio (AOR)=13.11, 95% CI: 12.49-13.76, p < 0.001] and non-alcoholic cirrhosis (AOR=11.53, 95% CI: 10.69-12.43, p < 0.001), followed by chronic hepatitis C (AOR=8.93, 95% CI:8.25-9.66, p < 0.001), alcoholic liver damage (AOR=7.05, 95% CI:6.30-7.88, p < 0.001), alcoholic liver cirrhosis (AOR=7.00, 95% CI:6.15-7.97, p < 0.001) and chronic hepatitis B (AOR=4.37, 95% CI:3.35-5.69, p < 0.001). African Americans with CLD were twice more likely to develop COVID-19 than Caucasians. Patients with COVID-19 and a recent encounter for CLD had a death rate of 10.3% (vs. 5.5% among COVID-19 patients without CLD, p < 0.001) and a hospitalization rate of 41.0% (vs. 23.9% among COVID-19 patients without CLD, p < 0.001).
Interpretation
Patients with CLD, especially African Americans, were at increased risk for COVID-19, highlighting the need to protect these patients from exposure to virus infection.
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