Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7362
Peer-review started: March 21, 2021
First decision: April 29, 2021
Revised: May 12, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: November 14, 2021
Coronavirus disease 2019 (COVID-19) disease severity and outcomes are affected by pre-existing chronic liver disease, particularly cirrhosis. Patients with decompensated liver cirrhosis (Child-Pugh classes B and C) are severely affected, with higher mortality rates than patients with compensated disease.
Comprehensive research on the outcome of COVID-19 in patients with isolated etiology of pre-existing chronic liver disease is needed to understand the clinical presentations and outcomes.
This study aimed to demonstrate the impact of COVID-19 factors affecting mortality among patients with pre-existing hepatitis C with or without liver cirrhosis during the first peak of the pandemic in Egypt.
This multicenter retrospective cohort study included 125 patients with COVID-19 at six quarantine hospitals in Egypt from May 1, 2020, to July 31, 2020. Clinical, laboratory features, COVID-19 severity, and outcomes were recorded. A regression analysis was performed to detect factors affecting mortality.
Fever, cough, dyspnea, and fatigue were the most frequent symptoms in patients with liver cirrhosis. Cough, sore throat, fatigue, myalgia, and diarrhea were significantly more common in patients with liver cirrhosis than in non-cirrhotic patients. Fifteen (23.4%) patients with liver cirrhosis presented with hepatic encephalopathy. Patients with liver cirrhosis were more likely to exhibit combined ground-glass opacities and consolidations in their chest CT scans and more likely to present with severe COVID-19 infection, compared to patients without liver cirrhosis. Mortality was higher among patients with liver cirrhosis: 33 (51.56%) vs 9 (14.75%), respectively (P value < 0.001. All patients in Child-Pugh class A recovered and were discharged, and mortalities occurred among patients in Child-Pugh classes B and C. A multivariate logistic regression revealed that male gender, diabetes mellitus, and liver cirrhosis were independent factors affecting mortality. Regarding liver function, COVID-19 disease severity, and outcomes, we found no difference between patients who previously received direct acting antiviral therapy (and achieved sustained virological response) and patients who did not receive such therapy.
Patients with decompensated hepatitis C virus-related liver cirrhosis are at higher risk of severe COVID-19 disease and mortality. Male gender, diabetes mellitus, and liver cirrhosis are the independent factors affecting mortality.
Male gender, diabetes mellitus, and liver cirrhosis significantly increased mortality in patients with COVID-19 and isolated hepatitis C virus-related chronic liver disease. Previous achievement of sustained virological response after direct acting antiviral therapy for chronic hepatitis C does not impact COVID-19 disease severity, outcome, or the results of liver function tests.