Predictors of Outcomes of COVID-19 in Patients With Chronic Liver Disease: US Multi-center Study

Donghee Kim, Nia Adeniji, Nyann Latt, Sonal Kumar, Patricia P. Bloom, Elizabeth S. Aby, Ponni Perumalswami, Marina Roytman, Michael Li, Alexander S. Vogel, Andreea M. Catana, Kara Wegermann, Rotonya M. Carr, Costica Aloman, Vincent L. Chen, Atoosa Rabiee, Brett Sadowski, Veronica Nguyen, Winston Dunn, Kenneth D. ChavinKali Zhou, Blanca Lizaola-Mayo, Akshata Moghe, José Debes, Tzu Hao Lee, Andrea D. Branch, Kathleen Viveiros, Walter Chan, David M. Chascsa, Paul Kwo, Renumathy Dhanasekaran*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

155 Scopus citations


Background & Aims: Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19). Methods: We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD. Results: Of the 978 patients in our cohort, 867 patients (mean age 56.9 ± 14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29–4.55), decompensated cirrhosis (HR 2.91 [1.70–5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53–7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47–3.70]) and decompensated cirrhosis (OR 2.50 [1.20–5.21]) were independently associated with risk for severe COVID-19. Conclusions: The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19.

Original languageEnglish
Pages (from-to)1469-1479.e19
JournalClinical Gastroenterology and Hepatology
Issue number7
StatePublished - Jul 2021
Externally publishedYes


  • Alcohol
  • COVID-19
  • Cirrhosis
  • Mortality


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