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  The Liver Meeting
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Washington on 04-08
November 2022
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Cirrhosis Linked to More Than Doubled Odds of Severe COVID
  AASLD-The Liver Meeting, November 4-8, 2022, Washington, DC
Mark Mascolini
Analysis of a large Canadian population linked cirrhosis to more than doubled odds of hospital admission of people with COVID and almost tripled odds of intensive care unit (ICU) admission [1]. Researchers from the British Columbia Centre for Disease Control (BCCDC) who ran this study say their findings underline the need for early treatment of COVID in people with cirrhosis.
Research ties cirrhosis to faulty immune function and a changed gut-liver axis, which can put people with cirrhosis at particularly high risk for infections and their complications. The BCCDC conducted this large population-based cohort study in Canada to weigh the impact of cirrhosis on two severe COVID outcomes-hospital admission and ICU use.
The investigators tapped data in the British Columbia COVID-19 Cohort, which catalogs lab-confirmed COVID cases and related hospital admissions, medical visits, emergency room visits, prescription drugs, chronic conditions, and deaths. The cirrhosis study focused on people at least 18 years old with a positive PCR for SARS-CoV-2 from January 1, 2021 (after the Canadian vaccination program began) to December 31, 2021. The researchers identified cirrhosis by a validated algorithm using ICD-9 and ICD-10 codes. Multivariable logistic regression adjusting for age, sex, comorbidities, income, geographic area, vaccination status, and SARS-CoV-2 variant explored potential associations between presence or absence of cirrhosis and COVID-related hospital and ICU admissions.
The analysis included 2511 people with COVID admitted to the ICU. Women made up 37% of the ICU population and men the remaining 63% (P < 0.001). The no-ICU group of 159,998 people with COVID consisted of equal proportions of women and men, 50% and 50%. Median age in the ICU group stood at 60, far above the median 38 years in the no-ICU group (P < 0.001). Compared with COVID patients who didn't need the ICU, those who did had significantly higher rates of cirrhosis, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and depression. While 59.2% of the no-ICU group had not been vaccinated against COVID, 82.4% of the ICU people never got a COVID vaccine.
Of the total 162,509 cohort members who tested positive for SARS-CoV-2, 768 (0.5%) had cirrhosis. And of those 768 people with COVID and cirrhosis, 230 (29.9%) got admitted to the hospital and 98 (12.8%) required ICU care. Multivariable logistic regression adjusted for sociodemographic and clinical variables linked having cirrhosis to more than 2.5-fold higher odds of going to the hospital for COVID (adjusted odds ratio [aOR] 2.55, 95% confidence interval [CI] 2.11 to 3.08) and to almost 2.9-fold higher odds of going to the ICU for COVID (aOR 2.87, 95% CI 2.23 to 3.70).
When the researchers broke down odds of hospital or ICU admission into three age groups, 18-49, 50-69, and 70+, they found that cirrhosis independently conferred higher odds of hospital or ICU admission in each of the three age groups. The magnitude of the association between cirrhosis and admission to the hospital or ICU was greatest in the 18-49 group: aOR 3.73 for hospital admission and 5.8 for ICU care.
BCCDC researchers argue that COVID vaccination and early treatment should be priorities for people with cirrhosis to prevent or ease severe COVID outcomes.
1. Velasquez Garcia H, Adu PA, Jeong D, et al. Risk of COVID-19 severe outcomes among people with cirrhosis: a population-based cohort study in Canada. AASLD-The Liver Meeting, November 4-8, 2022, Washington, DC. Abstract 2118.