Hepatology Communications (Jan 2023)

Long-Term Clinical Outcomes of Patients With COVID-19 and Chronic Liver Disease: US Multicenter COLD Study

  • Elizabeth S. Aby,
  • Ghady Moafa,
  • Nyan Latt,
  • Mohammad T. Sultan,
  • Paula A. Cacioppo,
  • Sonal Kumar,
  • Raymond T. Chung,
  • Patricia P. Bloom,
  • Jenna Gustafson,
  • Michael Daidone,
  • Zoe Reinus,
  • Jose D. Debes,
  • Sunny Sandhu,
  • Aalam Sohal,
  • Sameeha Khalid,
  • Marina Roytman,
  • Andreea Maria Catana,
  • Kara Wegermann,
  • Rotonya M. Carr,
  • Yedidya Saiman,
  • Ihab Kassab,
  • Vincent L. Chen,
  • Atoosa Rabiee,
  • Carly Rosenberg,
  • Veronica Nguyen,
  • Christina Gainey,
  • Kali Zhou,
  • Kenneth Chavin,
  • Blanca C. Lizaola-Mayo,
  • David M. Chascsa,
  • Lee Varelas,
  • Akshata Moghe,
  • Renumathy Dhanasekaran

DOI
https://doi.org/10.1097/01.HC9.0000897224.68874.de
Journal volume & issue
Vol. 7, no. 1
pp. e8874 – e8874

Abstract

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Background:. COVID-19 is associated with higher morbidity and mortality in patients with chronic liver diseases (CLDs). However, our understanding of the long-term outcomes of COVID-19 in patients with CLD is limited. Methods:. We conducted a multicenter, observational cohort study of adult patients with CLD who were diagnosed with COVID-19 before May 30, 2020, to determine long-term clinical outcomes. We used a control group of patients with CLD confirmed negative for COVID-19. Results:. We followed 666 patients with CLD (median age 58 years, 52.8% male) for a median of 384 (interquartile range: 31–462) days. The long-term mortality was 8.1%; with 3.6% experiencing delayed COVID-19-related mortality. Compared to a propensity-matched control group of patients with CLD without COVID-19 (n=1332), patients with CLD with COVID-19 had worse long-term survival [p<0.001; hazards ratio (HR): 1.69; 95% CI: 1.19–2.41] and higher rate of hospitalization (p<0.001, HR: 2.00, 1.62–2.48) over a 1-year follow-up period. Overall, 29.9% of patients reported symptoms of long-COVID-19. On multivariable analysis, female sex (p=0.05, HR: 2.45, 1.01–2.11), Hispanic ethnicity (p=0.003, HR: 1.94, 1.26–2.99), and severe COVID-19 requiring mechanical ventilation (p=0.028, HR: 1.74, 1.06–2.86) predicted long-COVID-19. In survivors, liver-related laboratory parameters showed significant improvement after COVID-19 resolution. COVID-19 vaccine status was available for 72% (n=470) of patients with CLD and history of COVID-19, of whom, 70% (n=326) had received the COVID-19 vaccine. Conclusions:. Our large, longitudinal, multicenter study demonstrates a high burden of long-term mortality and morbidity in patients with CLD and COVID-19. Symptoms consistent with long-COVID-19 were present in 30% of patients with CLD. These results illustrate the prolonged implications of COVID-19 both for recovering patients and for health care systems.