Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies

Abstract

Background: Coronavirus Disease 2019 (COVID-19) continues to pose a significant healthcare challenge throughout the world. Co-morbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed. Objectives: To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection Design/Method: Pubmed and Embase databases were searched for studies included up to 3rd February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the PRISMA guidelines. Risk of bias was assessed using the QUIPS risk of bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane Revman 5.4 software using a random effects model. Results: 63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality odds ratio (OR) of 2.48 (95% CI 2.02 – 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI 1.36-2.42). Conclusion: Cirrhosis is associated with an increased risk of all cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection such as shielding and prioritisation of vaccination.