High COVID-19 mortality rates among those with liver disease

A new international study has found high mortality rates from COVID-19 among people with chronic liver disease and cirrhosis.

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 percent 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.

The paper has been published online by the Journal of Hepatology.

Dr Thomas Marjot, who leads the project alongside Dr Gwilym Webb and Professor Ellie Barnes at the Translational Gastroenterology Unit at Oxford's John Radcliffe Hospital, said: "Until now, very little was known about the impact of COVID-19 on patients with pre-existing liver disease.

"Our data, which were gathered from 21 countries, show that people with liver disease, and especially those with decompensated cirrhosis, have particularly poor outcomes once they develop COVID-19.

"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 study also showed that many patients with cirrhosis and COVID-19 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.

However, Dr Marjot explained, these preliminary findings should be interpreted with caution: "our study is limited by selection bias; this is when doctors tend to report more severe cases with the worst outcomes. Many patients with cirrhosis and COVID-19 who have good outcomes will therefore not be included in the registry."

"Nonetheless, these findings do suggest high death rates with COVID-19 in patients with cirrhosis and 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 considered for coronavirus testing."

Pamela Healy, Chief Executive of the British Liver Trust said: "This important study demonstrates the devastating impact of coronavirus on liver patients. We are asking the Government to quickly review the shielding guidance and ensure that those with the most severe forms of liver disease have clear advice and support.

"Whilst lockdown may be easing for many of us, these patients often have multiple complex problems and urgently need clarity and to remain protected."