Prognosis of French COVID-19 patients with chronic liver disease: a national retrospective cohort study for 2020.

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There is uncertainty on the risk of dying after coronavirus disease 2019 (Covid-19) in chronic liver disease patients.We explored the outcomes of all Covid-19 adult inpatients in France, in 2020. We computed adjusted odds-ratios to measure the associations between chronic liver disease, alcohol use disorders, mechanical ventilation and day-30, in-hospital, mortality.The sample comprised 259,110 patients [median (interquartile range) age 70 (54, 83) years; 52% men], including 15,746 (6.0%) and 10,006 (3.9%) patients with chronic liver disease and alcohol use disorders, respectively. Mortality was 38,203 (15%) patients, including 7,475 (28%) after mechanical ventilation, and 2,941 (19%) with chronic liver disease. The adjusted odds-ratios for mechanical ventilation and day-30 mortality were 1.54 (95% confidence interval, 1.44 – 1.64, P < 0.001) and 1.79 (1.71 – 1.87, P < 0.001); 0.55 (0.47 – 0.64, P < 0.001) and 0.54 (0.48 – 0.61, P < 0.001); 0.64 (0.53 – 0.76; P < 0.001) and 0.71 (0.63- 0.80, P < 0.001); 0.65 (0.52 – 0.81, P < 0.001) and 2.21 (95% CI, 1.94 – 2.51, P < 0.001); 0.34 (0.24 – 0.50; P < 0.001) and 1.38 (1.17 – 1.62, P < 0.001); and 0.82 (0.76 – 0.89; P < 0.001) and 1.11 (1.05 – 1.17; P < 0.001) for chronic liver disease; mild liver disease; compensated cirrhosis; decompensated cirrhosis; primary liver cancer; and alcohol use disorders, respectively. Chronic viral hepatitis; non-viral, non-alcoholic chronic hepatitis; organ, including liver, transplantation, and acquired immunodeficiency syndrome were not associated with Covid-19 death.Chronic liver disease increased the risk Covid-19 death in France in 2020. Therapeutic effort limitation may have contributed to Covid-19 death of patients with a liver-related complication or with alcohol use disorders.We studied the outcomes, including mechanical ventilation and day-30 mortality, of all Covid-19 adults (N=259,110) discharged from acute and post-acute care, private and public hospitals, in France in 2020. Patients with mild liver disease; compensated cirrhosis; organ, including liver, transplantation; or acquired immunodepression syndrome were not at risk for Covid-19 mortality. Patients with alcohol use disorders; decompensated cirrhosis; or primary liver cancer were at high, positive, risk for Covid-19 mortality and at low, negative, risk for mechanical ventilation. Our results suggest that a limitation of the therapeutic effort may have contributed to the excess of mortality of patients with a liver-related complication and of patients with alcohol use disorders in France in 2020.

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Authors: Vincent Mallet, Nathanael Beeker, Samir Bouam, Philippe Sogni, Stanislas Pol, Demosthenes research group