Research collaboration with Stanford Medical School and the Palo Alto Veterans Institute for Research (PAVIR) is investigating the impact of underlying Chronic Liver Disease on patient outcomes following a COVID-19 infection.
Bethesda, MD - The Outcomes Research team at the Medical Technology and Practice Patterns Institute is pleased to announce its most recent publication in the Journal of Clinical and Experimental Hepatology titled Chronic Liver Disease and Cirrhosis are Associated with Worse Outcomes Following SARS-CoV-2 Infection. MTPPI and its collaborators at Stanford Medicine and the Palo Alto Veterans Institute for Research (PAVIR) studied data from the COVID-19 Research Database to analyze whether concurrent chronic liver disease (CLD) was associated with worse outcomes within 30 days of a COVID-19 diagnosis. Studied outcomes included the need for hospitalization, development of pneumonia, severe pneumonia, respiratory failure, and multiorgan failure.
The data source for this project was the COVID-19 Research Database, a large healthcare claims dataset that captures a network of 1 million distinct providers across professional and institutional claims and over 100 million patients with both inpatient and outpatient data representing >3000 different payers including private, Medicare, Medicare advantage, and Medicaid. The research team utilized the Snowflake analytics platform to build out the study cohort. Adults with a COVID-19 infection in the time range of 4/1/2020 to 8/31/2021 were identified using ICD-10 codes. The assessment of CLD focused on the four leading etiologies of liver disease among U.S. adults and included nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), alcohol-associated liver disease (ALD), hepatitis B virus (HBV), and hepatitis C virus (HCV).
The realized cohort included 1,208,905 unique patients with COVID-19, among which 44,008 (3.6%) had concurrent CLD and 1,164,897 (96.4%) did not have CLD. Among patients with concurrent CLD, 47.5% had ALD, 37.3% had NAFLD/NASH, 8.6% had chronic HCV, 4.1% had chronic HBV, and 2.5% had other etiologies. Compared to patients with COVID-19 without CLD, COVID-19+CLD patients were more likely to be male (51.4% vs. 44.4%, P < 0.0001) and were older (age >45: 72.7% vs. 61.5%, P < 0.0001). COVID-19+CLD patients had significantly greater prevalence of comorbidities compared to COVID-19 patients without CLD, including diabetes, hypertension, chronic kidney disease, heart failure, and chronic and respiratory disease.
This study found that the presence of underlying CLD, especially cirrhosis, is associated with significantly worse outcomes following COVID-19 infection. These results emphasize the importance of close monitoring of CLD patients following COVID-19 infection for any signs of clinical deterioration and further emphasize the importance of ensuring COVID-19 vaccination.
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