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High COVID-19 mortality rates among those with liver disease, study finds

A new international study has found increased mortality rates from COVID-19 among people with chronic liver disease and cirrhosis and has called for patients with worsening liver function to be tested for coronavirus.

The researchers, led by teams at Oxford University Hospitals NHS Foundation Trust and the University of North Carolina, set up an international registry to collect clinical details of patients with chronic liver disease and cirrhosis who develop COVID-19.

Between 25 March 2020 and 20 April 2020, 152 cases were submitted to the registry, over 95% of which were hospitalised. Patients with cirrhosis had poor outcomes with an overall death rate of 40 percent. Those with advanced disease called decompensated cirrhosis had the highest rate of death (between 43 and 63 percent), compared with 12 percent for patients with liver disease but without cirrhosis.

“Until now, very little was known about the impact of COVID-19 on patients with pre-existing liver disease. Our figures, which were gathered across 21 countries, show that people with liver disease, and especially those with cirrhosis and decompensated cirrhosis, have particularly poor outcomes if they develop COVID-19,” said Corresponding Author Dr Thomas Marjot, based in the Translational Gastroenterology Unit at Oxford’s John Radcliffe Hospital.

“Even when other risk factors for poor outcomes, such as age, obesity, diabetes and high blood pressure were taken into account, the severity of baseline liver disease was still associated with increased mortality,” he explained.

The figures also showed that many patients with cirrhosis and COVID-19 also developed features of worsening liver function (encephalopathy, ascites, bleeding), and in 24 percent of cases this occurred even without any chest symptoms or breathing difficulties.

This study is limited by selection bias; clinicians tend to report more severe cases and many patients with cirrhosis and COVID-19 who have good outcomes are not included in the registry.

“Nonetheless, these findings do suggest high death rates with COVID-19 in patients with cirrhosis. We have also seen that contracting the virus may lead to a deterioration in liver function. Therefore, anyone coming into hospital with worsening symptoms of liver disease should be tested for coronavirus as soon as possible.”


Related documents

Access the full study published by the Journal of Hepatology.

Find out about the EASL supported COVID-Hep registry

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