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Sun M, Liu S, Min J, Zhong L, Zhang J, Du Z. Predicting in-hospital mortality in patients with alcoholic cirrhosis complicated by severe acute kidney injury: development and validation of an explainable machine learning model. Front Med (Lausanne) 2025; 12:1570928. [PMID: 40406405 PMCID: PMC12095237 DOI: 10.3389/fmed.2025.1570928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Accepted: 04/16/2025] [Indexed: 05/26/2025] Open
Abstract
Background At present, there are no specialized models for predicting mortality risk in patients with alcoholic cirrhosis complicated by severe acute kidney injury (AKI) in the ICU. This study aims to develop and validate machine learning models to predict the mortality risk of this population during hospitalization. Methods A retrospective analysis was conducted on 856 adult patients with alcoholic cirrhosis complicated by severe AKI, utilizing data from the MIMIC-IV database. Within the dataset, 627 patients from the period 2008-2016 were designated as the training cohort, whereas 229 patients from 2017 to 2019 comprised the temporal external validation cohort. Feature selection was conducted utilizing LASSO regression, which was subsequently followed by the development of eight distinct machine learning models. The performance of these models in the temporal external validation cohort was rigorously assessed using the area under the receiver operating characteristic curve (AUROC) to determine the optimal model. The model was interpreted using the SHAP method, and nomograms were subsequently constructed. A comprehensive evaluation was performed from the perspectives of discrimination (assessed via AUROC and AUPRC), calibration (using calibration curves), and clinical utility (evaluated through DCA curves). Results LASSO regression identified nine key features: total bilirubin, acute respiratory failure, vasopressin, septic shock, oliguria, AKI stage, lactate, fresh frozen plasma transfusion, and norepinephrine. In the temporal external validation cohort, the Lasso-LR model achieved the highest AUROC value of 0.809, establishing it as the optimal model. We developed both a static nomogram and a web-based dynamic nomogram (https://zhangjingyu123456.shinyapps.io/dynnomapp/) for visualization purposes. In the nomogram model, the AUROC for the training cohort and temporal external validation cohort were 0.836 (95% CI: 0.802-0.870) and 0.809 (95% CI: 0.754-0.865), respectively. The calibration slope and Brier score for the training cohort were 1.000 and 0.146, respectively; for the temporal external validation cohort, these values were 0.808 and 0.177, respectively. The DCA curves indicate that the model has certain clinical application value. Conclusion The Lasso-LR model exhibits robust predictive capability for in-hospital mortality among patients with alcoholic cirrhosis complicated by AKI, offering valuable prognostic insights and individualized treatment decision support for healthcare professionals.
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Affiliation(s)
- Meina Sun
- Department of Intensive Care Unit, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Shihui Liu
- Department of Intensive Care Unit, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Jie Min
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
| | - Jinyu Zhang
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of General Surgery, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, China
| | - Zhian Du
- Department of Intensive Care Unit, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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Wang F, Zhu L, Chen Y, Li L. Clinical manifestations of SARS-CoV-2 Omicron infection is associated with the stage of liver cirrhosis. BMC Infect Dis 2025; 25:630. [PMID: 40301739 PMCID: PMC12042577 DOI: 10.1186/s12879-025-11040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 04/24/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND & AIM The impact of Omicron variants on cirrhosis was largely unknown. Herein, we aimed to evaluate the impact of SARS-CoV-2 omicron variants infection on the clinical course and mortality of patients with liver cirrhosis. METHODS Between 26 December 2022, and 27 January 2023, eighty-two hospitalized patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled. The clinical and pulmonary CT imaging features were retrospectively collected. A gender and age-matched cohort of 51 non-cirrhotic patients with COVID-19 were also included. RESULTS Our results indicated the symptom heterogeneity in patients with cirrhosis infected with omicron variants. Patients with more severe liver disease tended to have less severe respiratory symptoms and less pulmonary lesions. SARS-CoV-2 omicron did not cause obvious perturbation of liver function or cirrhosis decompensation. In comparison with hospitalized COVID-19 patients without liver cirrhosis, cirrhotic patients showed more severe pulmonary lesions and higher levels of inflammatory cytokine IL-6, but no significant increase in mortality. Multivariate analysis identified lung lesions proportion, MELD ≥ 15 score, and APTT as independent predictors for 28-day-mortality in these patients. CONCLUSION SARS-CoV-2 omicron variants caused a more severe inflammatory response in cirrhotic patients than in non-cirrhotic patients, but no further deterioration of liver function. Instead, patients with advanced stage of liver cirrhosis showed milder respiratory symptoms and pulmonary lesions. These results underscore the intricate relationship between Omicron infection and cirrhosis, highlighting the necessity for personalized clinical approaches in managing this specific patient group.
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Affiliation(s)
- Fengjiao Wang
- Shandong First Medical University, Jinan City, 250022, China
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan City, 250022, China
| | - Lingxiao Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Yanfei Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, 310003, China.
| | - Lanjuan Li
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan City, 250022, China.
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, 310003, China.
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Ismailova AG, Maslennikov RV, Zharkova MS, Ivashkin VT. Impact of Novel Coronavirus Infection on the Course and Prognosis of Cirrhosis. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2024; 33:65-80. [DOI: 10.22416/1382-4376-2023-33-6-65-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Аim: to investigate the impact of COVID-19 on the course and prognosis of cirrhosis.Materials and methods. This was a cohort study in patients with cirrhosis. We included patients with cirrhosis who underwent a medical examination at our center between September 2019 and March 2020. We determined which of these patients were infected with COVID-19, died of COVID-19, or died of cirrhosis complications within the follow-up period from April 2020 to September 2021. Thereafter, we conducted a second medical examination of these surviving patients with cirrhosis in September to December 2021.Results. Among the 226 patients included in the study, 57 had COVID-19, among which 19 patients who died of the disease. Acute-on-chronic liver failure (ACLF) developed in 16 (28.1 %) patients with cirrhosis and COVID-19, 13 (81.3 %) of whom died. One of the COVID-19 survivors eventually died of liver decompensation. Twenty patients who did not have COVID-19 died of complications of cirrhosis (ACLF) during the follow-up period. The mortality rate in patients who were infected with COVID-19 was higher than that in patients who were not infected (35.1 % vs. 14.2 %; p = 0.001). COVID-19 was an independent risk factor for death in patients with cirrhosis. No liver-specific factors predisposing to COVID-19 infection were identified. A more impaired liver function in the pre-pandemic medical examination was a predisposing factor for death in patients who had COVID-19. Patients who died of COVID-19 had better liver function in the pre-pandemic medical examination than patients without COVID-19 who died of complications of cirrhosis during the follow-up period. The liver-related mortality rate and the incidence of liver decompensation or bleeding from esophageal varices during the follow-up period were not significantly different between patients who recovered from COVID-19 and patients with cirrhosis who did not have COVID-19. Among the analyzed survivors, no significant changes were found in the main indicators of liver function after the follow-up period between patients with and without COVID-19, except for the prothrombin index, which was higher in patients after COVID-19.Conclusion. COVID-19 worsens the prognosis of patients with cirrhosis but does not substantially affect the course of cirrhosis after the recovery from this infection.
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Affiliation(s)
- A. G. Ismailova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - R. V. Maslennikov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. S. Zharkova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V. T. Ivashkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Casas-Deza D, Bernal-Monterde V, Betoré-Glaria E, Julián-Gomara AB, Yagüe-Caballero C, Sanz-París A, Fernández-Bonilla EM, Fuentes-Olmo J, Arbones-Mainar JM. Liver Disease Undernutrition Screening Tool Questionnaire Predicts Decompensation and Mortality in Cirrhotic Outpatients with Portal Hypertension. Nutrients 2023; 15:3780. [PMID: 37686812 PMCID: PMC10489934 DOI: 10.3390/nu15173780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Numerous scores are designed to predict outcomes of patients with liver cirrhosis. Our study aimed to evaluate the ability of the Liver Disease Undernutrition Screening Tool (LDUST) in predicting mortality and decompensation in outpatients with clinically significant portal hypertension (CSPH). We hypothesized that LDUST could help identify patients in need of nutritional supplementation and intervention. METHODS A prospective study of 57 CSPH patients (36.8% female, mean age: 63.5 ± 9.9 years) with a median follow-up of 41 months was conducted. Baseline liver function, nutrition, and sarcopenia were assessed, alongside LDUST. During follow-up, the occurrence of liver decompensation, hospital admission, need for emergency care, and mortality were evaluated. RESULTS A total of 56.1% of patients were Child A, and the most frequent etiology was alcohol (50.9%). Malnutrition risk according to LDUST raised mortality (HR: 25.96 (1.47-456.78)), decompensation (HR 9.78 (2.08-45.89)), and admission (HR 4.86 (1.09-21.61)) risks in multivariate Cox analysis. Combining LDUST with Child and MELD scores improved their decompensation prediction (0.936 vs. 0.811 and 0.866 vs. 0.700). CONCLUSIONS The LDUST has a solid ability to predict complications in cirrhosis outpatients with CSPH, and its integration with Child and MELD models enhances their predictive power. LDUST implementation could identify individuals necessitating early nutritional support.
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Affiliation(s)
- Diego Casas-Deza
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Vanesa Bernal-Monterde
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Elena Betoré-Glaria
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
| | - Ana Belén Julián-Gomara
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Carmen Yagüe-Caballero
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Alejandro Sanz-París
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
- Endocrinology and Nutrition Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Eva María Fernández-Bonilla
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
| | - Javier Fuentes-Olmo
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Jose M. Arbones-Mainar
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CiberOBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Walia D, Saraya A, Gunjan D. COVID-19 in patients with pre-existing chronic liver disease - predictors of outcomes. World J Virol 2023; 12:30-43. [PMID: 36743659 PMCID: PMC9896592 DOI: 10.5501/wjv.v12.i1.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/19/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has affected patients with pre-existing chronic liver disease (CLD) in various ways. The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinical outcomes in the form of increased risk of hepatic decompensation, acute-on-chronic liver failure, and even mortality. It is of paramount importance to identify various factors which are associated with unfavorable outcomes for prognostication and making informed management strategy. Many factors have been evaluated in different studies in patients with underlying CLD. Some of these factors include the severity of underlying chronic liver disease, comorbid conditions, age, and severity of COVID-19. Overall, the outcomes are not fav-orable in patients with cirrhosis as evidenced by data from various studies. The main purpose of this review is to identify the predictors of adverse clinical outcomes including mortality in patients with CLD for risk stratification, prognostication, and appropriate clinical management.
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Affiliation(s)
- Dinesh Walia
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, New Delhi, India
| | - Anoop Saraya
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, New Delhi, India
| | - Deepak Gunjan
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, New Delhi, India
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Zhang J, Zhao D, Hu J, Huang X, Gu Q, Tao Z. Hepatic dysfunctions in COVID-19 patients infected by the omicron variant of SARS-CoV-2. Front Public Health 2022; 10:1049006. [PMID: 36466505 PMCID: PMC9716022 DOI: 10.3389/fpubh.2022.1049006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Presently, the omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dominates amid the coronavirus disease 2019 (COVID-19) pandemic, but its clinical characteristics with intrinsic severity and organ tropism remain understudied. Methods We reported 1,001 mild COVID-19 patients that were infected with the omicron variant of SARS-CoV-2 and hospitalized in China from February to June 2022, including their demographic information, medical/immunization history, clinical symptom, and hematological profile. Patients with one-, two- and three-dose vaccination were compared to assess the vaccine effectiveness. Importantly, liver damage caused by the omicron variant infection was evaluated, in comparison to that caused by the wild-type or the delta variant SARS-CoV-2 infection. Results For the reported COVID-19 patients infected by the omicron variant of SARS-CoV-2, their median age was 36.0 [interquartile range (IQR): 26.0-50.0] and 49.7% were female. Hypertension, diabetes, and bronchitis were the leading comorbidities, and asymptomatic patients took up a major portion (61.2%). While most hematological parameters revealed the alleviated pathogenicity, full vaccination or booster shot showed effective protection against clinical severity. Furthermore, liver damages caused by viral infection of the omicron variant were largely attenuated when compared to those by infection of the wild-type or the delta variant SARS-CoV-2. Conclusions Our results supported that the viremic effect of the omicron variant tended to be modest, while the liver damage caused by this strain became milder than the previous circulating variants.
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Affiliation(s)
- Jianguo Zhang
- Department of Emergency Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Daguo Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhui Hu
- Department of Laboratory Medicine, Zhenjiang Hospital Affiliated to Nanjing University of Chinese Medicine, Zhenjiang Hospital of Traditional Chinese Medicine, Zhenjiang, China
| | - Xing Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qingqing Gu
- Department of Infectious Diseases, The Affiliated Hospital of Kangda College of Nanjing Medical University, The Fourth People's Hospital of Lianyungang, Lianyungang, China
| | - Zhimin Tao
- Department of Emergency Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- Jiangsu Province Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
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Li P, Liu Y, Cheng Z, Yu X, Li Y. COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management. Biomed Pharmacother 2022; 154:113568. [PMID: 36029543 PMCID: PMC9381432 DOI: 10.1016/j.biopha.2022.113568] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global epidemic and poses a major threat to public health. In addition to COVID-19 manifesting as a respiratory disease, patients with severe disease also have complications in extrapulmonary organs, including liver damage. Abnormal liver function is relatively common in COVID-19 patients; its clinical manifestations can range from an asymptomatic elevation of liver enzymes to decompensated hepatic function, and liver injury is more prevalent in severe and critical patients. Liver injury in COVID-19 patients is a comprehensive effect mediated by multiple factors, including liver damage directly caused by SARS-CoV-2, drug-induced liver damage, hypoxia reperfusion dysfunction, immune stress and inflammatory factor storms. Patients with chronic liver disease (especially alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma) are at increased risk of severe disease and death after infection with SARS-CoV-2, and COVID-19 aggravates liver damage in patients with chronic liver disease. This article reviews the latest SARS-CoV-2 reports, focusing on the liver damage caused by COVID-19 and the underlying mechanism, and expounds on the risk, treatment and vaccine safety of SARS-CoV-2 in patients with chronic liver disease and liver transplantation.
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Affiliation(s)
- Penghui Li
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Ying Liu
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Ziqi Cheng
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Xiaorui Yu
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yinxiong Li
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; China-New Zealand Joint Laboratory on Biomedicine and Health, Guangzhou, China.
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Nawghare P, Jain S, Chandnani S, Bansal S, Patel S, Debnath P, Rane S, Deshmukh R, Rathi P, Contractor Q. Predictors of Severity and Mortality in Chronic Liver Disease Patients With COVID-19 During the Second Wave of the Pandemic in India. Cureus 2022; 14:e20891. [PMID: 35145796 PMCID: PMC8809206 DOI: 10.7759/cureus.20891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) infection in chronic liver disease patients is associated with poor outcomes. In this study, we aimed to evaluate the predictors of severity and mortality in this group of patients during the second wave of the COVID-19 pandemic in India. In addition, we compared cirrhotic patients with COVID-19 with cirrhotic patients from the pre-COVID-19 period. Methodology This was a single-center observational study. We included data from 50 patients with cirrhosis and COVID-19 retrospectively from the discharge/death files. A comparison group of 100 patients with cirrhosis from the pre-COVID period was also analyzed retrospectively. Results The majority of patients had predominantly respiratory symptoms, with fever being the most common symptom (85%). The most common presentation was acute on chronic liver failure (ACLF). The most common form of decompensation was jaundice followed by hepatic encephalopathy. The overall mortality in cirrhotic patients with COVID-19 was double than that in cirrhotic patients from the pre-COVID-19 period. All patients with ACLF succumbed to multiorgan failure. Diabetes was the only comorbidity that was associated with severe infection. Higher creatinine on admission and high D-dimer levels correlated with severity. D-dimer was the only parameter that correlated with severity and mortality on multivariate analysis. None of the comorbidities predicted mortality. Among various composite scores, the Child-Turcotte-Pugh (CTP) score and CURB-65 correlated with mortality. On the area under the receiver operating characteristic analysis, a D-dimer level of >1.1 mg/L was associated with mortality. Conclusions COVID-19 infection in patients with cirrhosis is associated with poor outcomes. D-dimer levels of >1.1 mg/L on admission are a simple parameter to predict mortality. CTP and CURB-65 are composite scores that correlate with mortality in this group of patients.
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