S1162 Impact of Chronic Liver Disease on Outcomes of Hospitalized Patients With COVID-19: A Multicenter United States Experience

Abstract

INTRODUCTION: Liver injury has been described with COVID-19, and early reports suggested 2–11% of patients had chronic liver disease (CLD). However, there are limited reports on the nature of liver disease among COVID-19 patients and how underlying CLD influences clinical outcomes. Given the high prevalence of NAFLD in the US, as well as metabolic syndrome and obesity being potential poor prognostic factors for COVID-19, we hypothesized that CLD, particularly NAFLD, may be associated with more severe clinical course and worse outcomes among patients with COVID-19. We aimed to study the effect of existing liver-related comorbidities on the manifestations and outcomes of hospitalized adults with COVID-19. METHODS: This was a multicenter retrospective study of hospitalized adults with laboratory-confirmed COVID-19. The primary outcome was the impact of CLD on disease severity, including hospital length of stay, ICU admission, need for mechanical ventilation, and death. Secondary outcomes included the comparisons of patient characteristics, other clinical manifestations of disease, and laboratory results on admission between patients with and without CLD. Further analyses were performed by stratifying patients with CLD into those with and without cirrhosis, and into NAFLD and non-NAFLD. Student’s t-test/Fisher Exact test were performed for univariate analyses; logistic regression were performed for multivariable analyses. RESULTS: Of 363 patients included, 69 (19%) had CLD, including 55 (15.2%) with NAFLD. Patients with CLD had longer length of stay (Table 1). After controlling for age, gender, obesity, cardiac diseases, hypertension, hyperlipidemia, diabetes, and pulmonary disorders, CLD and NAFLD were independently associated with ICU admission [(aOR 1.77, 95% CI 1.03–3.04) and (aOR 2.30, 95% CI 1.27–4.17)] and mechanical ventilation [(aOR 2.08, 95% CI 1.20–3.60) and (aOR 2.15, 95% CI 1.18–3.91)] (Table 2). Presence of cirrhosis was an independent predictor of mortality (aOR 12.5, 95% CI 2.16–72.5). CONCLUSION: Overall, nearly one-fifth of hospitalized COVID-19 patients had CLD, which was associated with more critical illness. This association was observed in patients with NAFLD but not in those with non-NAFLD CLD. This difference might, in part, be secondary to the association between NAFLD and obesity, inflammation and oxidative stress. While patients with NAFLD were more likely to be admitted to the ICU and require mechanical ventilation, only those with cirrhosis had an increased risk of mortality.Table 1.: Baseline characteristics and admission laboratory data of patients hospitalized with COVID-19Table 2.: Multivariable analyses for (A) the need for mechanical ventilation, (B) ICU admission, and (C) death