A recent study by German scientists has revealed that COVID-19 infection among patients with cirrhosis is initially asymptomatic as compared to those without fibrosis in the liver. The findings of the study was published in United European Gastroenterology Journal on Thursday. The aim of the study led by Tony Bruns, Jacob Nattermann, and Fabian Geisler was to determine the extent to which comorbidities contribute to excess COVID-19 mortality in cirrhosis. According to the scientists, various international registries have reported high mortality rates in patients with liver disease and COVID-19.
During their study, the researchers used the multinational Lean European Open Survey on SARS-CoV-2-infected patients (LEOSS) to identify patients with cirrhosis documented between March 2020 and March 2021. During this period, the wild-type and alpha variants were predominant.
While examining the documents, the team of scientists compared symptoms, disease progression, and mortality after propensity score matching (PSM) for age, sex, obesity, smoking status, and concomitant diseases. Moreover, they also compared mortality with that of patients with spontaneous bacterial peritonitis (SBP) without SARS-CoV-2 infection which is a common bacterial infection and well-described precipitator of acute-on-chronic liver failure.
“Among 7096 patients with SARS-CoV-2 infection eligible for analysis, 70 (0.99%) had cirrhosis, and all were hospitalised. Case fatality rate in patients with cirrhosis was 31.4 percent with the highest odds of death in patients older than 65 years (43.6% mortality; odds ratio [OR] 4.02; p = 0.018), Child-Pugh class C (57.1%; OR 4.00; p = 0.026), and failure of two or more organs (81.8%; OR 19.93; p = 0.001),” the study revealed.
According to the study, the risk factors for severe COVID-19 which include diabetes, renal disease, and cardiovascular disease were more frequent in patients with cirrhosis.
The scientists found that before matching, the case fatality rate was higher in patients with cirrhosis and COVID-19 infection as compared to those without cirrhosis. Meanwhile, the matched patients had a similar case fatality rate. According to the scientists, this highlighted a role of cirrhosis-associated extrahepatic comorbidities and complications.
Cirrhosis is a late stage of scarring (fibrosis) of the liver. According to doctors and health experts, it is caused by various reasons like hepatitis and chronic alcoholism. If this scarring advances further, a liver transplant may be required.
The findings of the study revealed that COVID-19 infected patients with cirrhosis have significant extrahepatic comorbidities and they are often asymptomatic during the initial days of the infection. The scientists also emphasised that COVID-19 associated mortality in patients with cirrhosis was largely related to extrahepatic comorbidities in the study.