COVID-19 death rates ‘four times higher’ among those with cirrhosis

Posted on: 6th October 2020

Today, researchers at Oxford University Hospitals NHS Foundation have released new data about the specific groups of people with liver disease who are at a greater risk of dying if they catch coronavirus. The study suggests, people who have had a liver transplant who contract COVID-19 are at no increased risk but that death rates can be ‘four times higher’ among those with cirrhosis.

The paper presented data on over 1,300 patients from 29 different countries and compared COVID-19 outcomes between patients with and without liver disease.

“Our study confirms that severity of liver disease is closely associated with poor outcomes from COVID-19, with cirrhosis patients being at significantly increased risk of death,” said Dr Thomas Marjot, who leads the study alongside Professor Eleanor Barnes at Oxford University Hospitals.

“Given the huge global burden of cirrhosis, with an estimated 112 million people affected, and the resurgence of the virus in many areas of the world these findings have far-reaching implications for how we manage patients with liver disease during the pandemic. This includes the need to consider enhanced protection and social distancing for patients with advanced cirrhosis,” Dr Marjot explained.

The international study, published in Journal of Hepatology, found that mortality among patients with cirrhosis was 32%, compared with 8% in those without. However, the risk of mortality increased in those with more advanced forms of cirrhosis, rising as high as 51% in those in the most severe category. Other risk factors for death included advancing age and alcohol-related liver disease.

Professor Stephen Ryder, Medical Advisor to the British Liver Trust says, “We understand that the results will be alarming if you or loved one has cirrhosis of the liver. It’s important to remember that there is a certain amount of bias in these results as the doctors often only submit data to the registry for the most serious cases they see and the vast majority of patients in the study were hospitalised. This means that milder cases are often not included.  The study shows that the more advanced your liver disease is, the worse your likely outcome will be if you do contract the virus. The results clearly endorse the British Liver Trust’s position that those who have decompensated liver disease are extremely vulnerable and should be included in the ‘shielding group’.

“Our advice is that the most important thing you can do to protect yourself if you have cirrhosis is to strictly follow the current guidelines and social distancing rules.”

The majority of deaths in cirrhosis patients (71%) were from respiratory failure caused by COVID-19. The virus also seemed to cause a deterioration in liver function, with patients developing complications such as ascites or encephalopathy even in the absence of typical respiratory symptoms of COVID-19.

This study follows a recent publication from the same group in The Lancet Gastroenterology & Hepatology which showed that liver transplant recipients did not appear to be at increased risk of death from the virus.

The initial results from this study indicate that, assuming no other risk factors or comorbidities, people who have had a liver transplant who contract coronavirus are not at an increased risk of death compared with the general population.

Dr Andrew Moon at The University of North Carolina said “In contrast to the presence of advanced cirrhosis, having a liver transplantation was not associated with increased risk of death from COVID-19. This suggests that we should aim to continue liver transplant services during the pandemic wherever possible”.