Survival COVID-19 in Adult Patients with Liver Cirrhosis

Gita Aprilicia(1), Syahrizal Syarif(2), Kemal Fariz Kalista(3), Andri Sanityoso Sulaiman(4), Irsan Hasan(5), Cosmas Rinaldi A Lesmana(6), Juferdy Kurniawan(7), Chyntia Olivia Maurine Jasirwan(8), Saut Horas Hatoguan Nababan(9), Rino Alvani Gani(10),


(1) Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok
(2) Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok
(3) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(4) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(5) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(6) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(7) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(8) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(9) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
(10) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta
Corresponding Author

Abstract


Background: COVID-19 is a disease caused by infection of SARS-CoV-2 virus which leads to mortality due to respiratory failure. The progression of COVID-19 is more severe in patients with pre-existence morbidities, including liver disease. Recently, a few studie showed that liver cirrhosis patients with COVID-19 had a higher risk of mortality rather than liver cirrhosis patients without COVID-19 infection. Nevertheless, the study of survival COVID-19 in a patient with underlying liver cirrhosis is still limited. The aim of this study is to evaluate the survival of COVID-19 in adult patients with liver cirrhosis

Method: An observational study in Cipto Mangunkusumo Hospital was conducted. Patients with underlying liver cirrhosis between March 2020-January 2021 with positive confirmation of COVID-19 were enrolled in this study. Liver cirrhosis patients without COVID-19 were enrolled as a comparison. Both liver cirrhosis patients with and without COVID-19 were follow up at the time of hospital admission until 30 days outcome. Kaplan Meier and a log-rank test were conducted to evaluate the comparison of survival rate in liver cirrhosis patients with and without COVID-19. Multivariate Cox Proportional Hazard was conducted to identify the independent risk factors related to survival.

Results: There were 22 liver cirrhosis patients with COVID-19 and 116 liver cirrhosis patients included in this study. Presentation of gender and age similar both of them. Predominantly males with average age were 57 years ± 13,60 for cirrhosis with COVID-19 patients and 53 years ± 12,75 for without COVID-19. The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19  (35.8% vs. 67.2%, p-value 0.001). Median survival of liver cirrhosis patients with COVID-19 was 4 days (95% CI: 1-8 days), while median survival of liver cirrhosis patients without COVID-19 couldn’t be reached since the survival rate of this group above 50%. Final model Cox PH showed that liver cirrhosis with COVID-19 (HR: 8.99; CI 95%: 4.55 – 17.80, p-value 0.001) and Child-Pugh class C (HR: 5.61; 95% CI: 2.76 – 11.40, p-value 0.001) were the independent risk factors associated with poor survival.

Conclusion: The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19. Liver cirrhosis with COVID-19 and Child-Pugh class C were associated with poor survival.


Keywords


COVID-19; liver cirrhosis; survival rate

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DOI: 10.24871/2222021124-129

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