Yong Xiao1, Dongwen Wu2, Xiao Shi2, Shuzhong Liu1, Xudong Hu3, Chenliang Zhou4, Xia Tian5, Huimin Liu6, Hui Long7, Zhihong Li8, Ji Wang9, Tao Tan10, Ying Xu11, Bitao Chen12, Ting Liu13, Heng Zhang14, Shihua Zheng15, Shunlin Hu16, Jun Song17, Jie Tang18, Jichun Song19, Zhengwei Cheng20, Weitian Xu21, Yongxiang Shen22, Wenhu Yu23, Yong Xu24, Jiao Li1, Jing Zhou1, Fen Wang2, Mingkai Chen1. 1. Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China. 2. Department of Gastroenterology, The Third XiangYa Hospital Central South University, Changsha, Hunan, China. 3. Department of Gastroenterology, Wuhan Jinyintan Hospital, Wuhan, Hubei, China. 4. Intensive Care Unit, Renmin Hospital of Wuhan University, Wuhan, Hubei, China. 5. Department of Gastroenterology, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, Hubei, China. 6. Department of Gastroenterology, The Second Affiliated Hospital of Jianghan University (Wuhan Fifth Hospital), Wuhan, Hubei, China. 7. Department of Gastroenterology, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, China. 8. Emergency Center, the Central Hospital of Xiaogan, Xiaogan, Hubei, China. 9. Department of Gastroenterology, Hanyang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China. 10. Department of Gastroenterology, Third People's Hospital of Hubei Provincial, Wuhan, Hubei, China. 11. Department of Gastroenterology, Wuhan Hankou Hospital, Wuhan, Hubei, China. 12. Department of Gastroenterology, Jingmen No.1 People's Hospital, Jingmen, Hubei, China. 13. Department of Gastroenterology, Wuhan Ninth Hospital, Wuhan, Hubei, China. 14. Department of Gastroenterology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 15. Department of Gastroenterology, Yichang Central People's Hospital, Yichang, Hubei, China. 16. Department of Gastroenterology, Xiangyang No.1 People's Hospita, Xiangyang, Hubei, China. 17. Department of Gastroenterology, Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, Hubei, China. 18. Department of Orthopedic, Wuhan Fourth Hospital, Wuhan, Hubei, China. 19. Department of Gastroenterology, Chibi Genral Hospital, Chibi, Hubei, China. 20. Department of Gastroenterology, Tongji Xianning Hospital, Huazhong University of Science and Technology, Xianning, Hubei, China. 21. Department of Gastroenterology, Central Theater General Hospital, Wuhan, Hubei, China. 22. Department of Gastroenterology, The First People's Hospital of Tianmen Hubei Province, Tianmen, Hubei, China. 23. Department of Gastroenterology, Xiantao First People's Hospital, Xiantao, China. 24. Department of Gastroenterology, Tongcheng People's Hospital, Tongcheng, Hubei, China.
Abstract
Background: COVID-19 has rapidly become a major health emergency worldwide. The characteristic, outcome, and risk factor of COVID-19 in patients with decompensated cirrhosis remain unclear. Methods: Medical records were collected from 23 Chinese hospitals. Patients with decompensated cirrhosis and age- and sex-matched non-liver disease patients were enrolled with 1:4 ratio using stratified sampling. Results: There were more comorbidities with higher Chalson Complication Index (p < 0.001), higher proportion of patients having gastrointestinal bleeding, jaundice, ascites, and diarrhea among those patients (p < 0.05) and in decompensated cirrhosis patients. Mortality (p < 0.05) and the proportion of severe ill (p < 0.001) were significantly high among those patients. Patients in severe ill subgroup had higher mortality (p < 0.001), MELD, and CRUB65 score but lower lymphocytes count. Besides, this subgroup had larger proportion of patients with abnormal (PT), activated partial thromboplatin time (APTT), D-Dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBL) and Creatinine (Cr) (p < 0.05). Multivariate logistic regression for severity shown that MELD and CRUB65 score reached significance. Higher Child-Pugh and CRUB65 scores were found among non-survival cases and multivariate logistic regression further inferred risk factors for adverse outcome. Receiver Operating Characteristic (ROC) curves also provided remarkable demonstrations for the predictive ability of Child-Pugh and CRUB65 scores.Conclusions: COVID-19 patients with cirrhosis had larger proportion of more severely disease and higher mortality. MELD and CRUB65 score at hospital admission may predict COVID-19 severity while Child-Pugh and CRUB65 score were highly associated with non-survival among those patients.
Background: COVID-19 has rapidly become a major health emergency worldwide. The characteristic, outcome, and risk factor of COVID-19 in patients with decompensated cirrhosis remain unclear. Methods: Medical records were collected from 23 Chinese hospitals. Patients with decompensated cirrhosis and age- and sex-matched non-liver diseasepatients were enrolled with 1:4 ratio using stratified sampling. Results: There were more comorbidities with higher Chalson Complication Index (p < 0.001), higher proportion of patients having gastrointestinal bleeding, jaundice, ascites, and diarrhea among those patients (p < 0.05) and in decompensated cirrhosispatients. Mortality (p < 0.05) and the proportion of severe ill (p < 0.001) were significantly high among those patients. Patients in severe ill subgroup had higher mortality (p < 0.001), MELD, and CRUB65 score but lower lymphocytes count. Besides, this subgroup had larger proportion of patients with abnormal (PT), activated partial thromboplatin time (APTT), D-Dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBL) and Creatinine (Cr) (p < 0.05). Multivariate logistic regression for severity shown that MELD and CRUB65 score reached significance. Higher Child-Pugh and CRUB65 scores were found among non-survival cases and multivariate logistic regression further inferred risk factors for adverse outcome. Receiver Operating Characteristic (ROC) curves also provided remarkable demonstrations for the predictive ability of Child-Pugh and CRUB65 scores.Conclusions: COVID-19patients with cirrhosis had larger proportion of more severely disease and higher mortality. MELD and CRUB65 score at hospital admission may predict COVID-19 severity while Child-Pugh and CRUB65 score were highly associated with non-survival among those patients.