Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study

Abstract Background and aims Some, but not all, prior studies have suggested that patients with chronic liver disease are at increased risk of contracting COVID-19 and developing more severe disease. However, nationwide data are lacking from well-phenotyped cohorts with liver histology and compariso...

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Autores principales:	Tracey G. Simon, Hannes Hagström, Rajani Sharma, Jonas Söderling, Bjorn Roelstraete, Emma Larsson, Jonas F. Ludvigsson
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Corona virus COVID Liver disease Cirrhosis Survival Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/eff27d36410f46c6a6dd559ef11d649e
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spelling	oai:doaj.org-article:eff27d36410f46c6a6dd559ef11d649e2021-11-28T12:15:00ZRisk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study10.1186/s12876-021-02017-81471-230Xhttps://doaj.org/article/eff27d36410f46c6a6dd559ef11d649e2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12876-021-02017-8https://doaj.org/toc/1471-230XAbstract Background and aims Some, but not all, prior studies have suggested that patients with chronic liver disease are at increased risk of contracting COVID-19 and developing more severe disease. However, nationwide data are lacking from well-phenotyped cohorts with liver histology and comparisons to matched general population controls. Methods We conducted a nationwide cohort study of all Swedish adults with chronic liver disease (CLD) confirmed by liver biopsy between 1966 and 2017 (n = 42,320), who were alive on February 1, 2020. CLD cases were matched to ≤ 5 population comparators by age, sex, calendar year and county (n = 182,147). Using Cox regression, we estimated multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for COVID-19 hospitalization and severe COVID-19 (intensive care admission or death due to COVID-19). Results Between February 1 and July 31, 2020, 161 (0.38%) CLD patients and 435 (0.24%) general population controls were hospitalized with COVID-19 (aHR = 1.36, 95% CI = 1.11–1.66), while 65 (0.15%) CLD patients and 191 (0.10%) controls developed severe COVID-19 (aHR = 1.08, 95% CI = 0.79–1.48). Results were similar in patients with CLD due to alcohol use, nonalcoholic fatty liver disease, viral hepatitis, autoimmune hepatitis, and other etiologies. Among patients with cirrhosis (n = 2549), the aHRs for COVID-19 hospitalization and for severe COVID-19 were 1.08 (95% CI 0.48–2.40) and 1.23 (95% CI = 0.37–4.04), respectively, compared to controls. Moreover, among all patients diagnosed with COVID-19, the presence of underlying CLD was not associated with increased mortality (aHR = 0.85, 95% CI = 0.61–1.19). Conclusions In this nationwide cohort, patients with CLD had a higher risk of hospitalization for COVID-19 compared to the general population, but they did not have an increased risk of developing severe COVID-19.Tracey G. SimonHannes HagströmRajani SharmaJonas SöderlingBjorn RoelstraeteEmma LarssonJonas F. LudvigssonBMCarticleCorona virusCOVIDLiver diseaseCirrhosisSurvivalDiseases of the digestive system. GastroenterologyRC799-869ENBMC Gastroenterology, Vol 21, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Corona virus COVID Liver disease Cirrhosis Survival Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Corona virus COVID Liver disease Cirrhosis Survival Diseases of the digestive system. Gastroenterology RC799-869 Tracey G. Simon Hannes Hagström Rajani Sharma Jonas Söderling Bjorn Roelstraete Emma Larsson Jonas F. Ludvigsson Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
description	Abstract Background and aims Some, but not all, prior studies have suggested that patients with chronic liver disease are at increased risk of contracting COVID-19 and developing more severe disease. However, nationwide data are lacking from well-phenotyped cohorts with liver histology and comparisons to matched general population controls. Methods We conducted a nationwide cohort study of all Swedish adults with chronic liver disease (CLD) confirmed by liver biopsy between 1966 and 2017 (n = 42,320), who were alive on February 1, 2020. CLD cases were matched to ≤ 5 population comparators by age, sex, calendar year and county (n = 182,147). Using Cox regression, we estimated multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for COVID-19 hospitalization and severe COVID-19 (intensive care admission or death due to COVID-19). Results Between February 1 and July 31, 2020, 161 (0.38%) CLD patients and 435 (0.24%) general population controls were hospitalized with COVID-19 (aHR = 1.36, 95% CI = 1.11–1.66), while 65 (0.15%) CLD patients and 191 (0.10%) controls developed severe COVID-19 (aHR = 1.08, 95% CI = 0.79–1.48). Results were similar in patients with CLD due to alcohol use, nonalcoholic fatty liver disease, viral hepatitis, autoimmune hepatitis, and other etiologies. Among patients with cirrhosis (n = 2549), the aHRs for COVID-19 hospitalization and for severe COVID-19 were 1.08 (95% CI 0.48–2.40) and 1.23 (95% CI = 0.37–4.04), respectively, compared to controls. Moreover, among all patients diagnosed with COVID-19, the presence of underlying CLD was not associated with increased mortality (aHR = 0.85, 95% CI = 0.61–1.19). Conclusions In this nationwide cohort, patients with CLD had a higher risk of hospitalization for COVID-19 compared to the general population, but they did not have an increased risk of developing severe COVID-19.
format	article
author	Tracey G. Simon Hannes Hagström Rajani Sharma Jonas Söderling Bjorn Roelstraete Emma Larsson Jonas F. Ludvigsson
author_facet	Tracey G. Simon Hannes Hagström Rajani Sharma Jonas Söderling Bjorn Roelstraete Emma Larsson Jonas F. Ludvigsson
author_sort	Tracey G. Simon
title	Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
title_short	Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
title_full	Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
title_fullStr	Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
title_full_unstemmed	Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
title_sort	risk of severe covid-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/eff27d36410f46c6a6dd559ef11d649e
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Risk of severe COVID-19 and mortality in patients with established chronic liver disease: a nationwide matched cohort study

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