Table 2.
Summary of selected studies depicting COVID-19 outcomes in patients with liver diseases, viral hepatitis, and liver transplantation.
| COVID-19 studies | Study design | Study region | Demographic and clinical characteristics of patients | Association with mortality | Disease severity and mortality risks |
|---|---|---|---|---|---|
| Marjot et al. (Oct 2020) [148] | Large international Registry study | 29 countries | COVID-19 plus cirrhosis (n = 386); COVID-19 plus CLD without cirrhosis (n = 359); COVID-19 plus non-CLD (n = 620); COVID-19 plus CLD (n = 745); COVID-19 plus ALD; COVID-19 plus HCC (n = 48); COVID-19 plus HBV (n = 96); COVID-19 plus HCV (n = 92) | Yes | Overall mortality based on Child-pugh class A (CP-A) score; 19 %, CP-B; 35 %, CP-C; 51 %. Increased risk of death cirrhosis vs CLD without cirrhosis: CP-A (OR 1.9, 95 % CI 1.03–3.5), CP-B (OR 4.1, 95 % CI 2.4–7.77), CP-C (OR 9.32, 95 % CI 4.80–18); ALD independent risk factor for mortality in COVID-19 plus ALD (OR 1.79, 95 % CI 1.03–3.13); COVID-19 plus HCC→ no independent association with mortality; COVID-19 plus HBV & HCV→ no independent association with mortality |
| Lee et al. (Oct 2020) [175] | Multicenter study | South Korea | COVID-19 plus with liver-related comorbidities (4.7 %); COVID-19 plus liver cirrhosis (1.4 %); COVID-19 plus cirrhosis with severe pneumonia (4.5 %); COVID-19 plus cirrhosis with non-severe pneumonia (0.9 %) | Yes | Overall less survival rate in COVID-19 plus liver cirrhosis as compared to COVID-19 without liver cirrhosis (log-rank test, P = 0.003); Disease severity risk in patients with COVID-19 plus liver cirrhosis (OR, 4.52; 95 % CI, 1.20–17.02; P = 0.026) and death (hazard ratio, 2.86; 95 % CI, 1.04–9.30; P = 0.042) |
| Vázquez-Medina et al. (Aug 2022) [176] | Retrospective study | Mexico | COVID-19 plus metabolic disorders (NAFLD, MAFLD & AF; n = 359) | Yes | Mortality rate COVID-19 plus NAFLD than COVID-19 without NAFLD (55 % vs. 38.3 %, P = 0.02); Disease severity risk in COVID-19 plus MAFLD (44.09 % vs. 20 %, P = 0.001) and COVID-19 plus NAFLD (40.51 % vs. 20 %, P = 0.01) than the control group. A significant association between COVID-19 plus NAFLD, advanced fibrosis, and death (P = 0.01). A significant interaction between COVID-19 plus MAFLD, advanced fibrosis, and death (P = 0.006) and intubation (P = 0.049). |
| Shao et al. (Feb 2021) [177] | Retrospective study | China | COVID-19 plus CLDs, metabolic disorders, and viral hepatitis (n = 1520); COVID-19 plus CLD (n = 127; 8.35 %); COVID-19 plus HBV (n = 64); COVID-19 plus CHC (n = 20), COVID-19 plus FLD (n = 37), COVID-19 plus cirrhosis (n = 6) | Yes | Overall higher rates of mortality (21.74 %; P<0.001) associated with CLDs and ICU admission (26.71 %; P<0.001); Increased risks for COVID-19 severity with FLD and cirrhosis; COVID-19-related mortality significant with hypertension between the groups (27.56 % with CLD vs. 37.19 % without CLD; P = 0.034) |
| Singh et al. (Oct 2022) [178] | Multicenter research network study | USA | COVID-19 infected patients (n = 2780); COVID-19 plus preexisting liver disease (n = 250; 9 %); COVID-19 plus cirrhosis (n = 50; 1.8 %); COVID-19 plus NAFLD (42 %) | Yes | Overall higher risk of mortality in the COVID-19 plus LD group (RR 2.8; 95 % CI,1.9–4.0; P < .001); COVID-19 plus cirrhosis had an even higher relative risk of mortality (RR, 4.6; 95 % CI, 2.6–8.3; P < .001); Higher risk of hospitalization for COVID-19 plus LD group |
| Moon et al. (Sep 2020) [179] | Two international registry | 21 countries | COVID-19 plus cirrhosis (n = 103); COVID-19 plus CLD (n = 49); COVID-19 plus NAFLD (22.4 %); COVID-19 plus ALD (19.7 %); COVID-19 plus HBV (11.8 %); COVID-19 plus HCV (10.5 %) | Yes | Higher mortality in COVID-19 plus cirrhosis (39.8 %) and increased disease severity (27.8 %); Mortality in COVID-19 plus CLD but without cirrhosis (12.2 %); CP-A (23.9 %), CP-B (43.3 %) and CP-C (63 %); mortality in COVID-19 plus hepatic decompensation (63.2 %) compared to 26.2 % without it. |
| Ji et al. (Aug 2020) [20] | Retrospective study | China | COVID-19 plus NAFLD (n = 202); COVID-19 plus hepatic injury (n = 101; 50 %; n = 152; 75.2 %) on admission and during hospitalization respectively | Yes | Higher risk of disease progression in COVID-19 plus NAFLD (6.6 %; n = 5 vs. 44.7 %; n = 34/76; p <0.0001) |
| Ge et al. (Aug 2020) [180] | National COVID cohort study | USA | COVID-19 plus cirrhosis (n = 8941; 4 %); COVID-19 plus cirrhosis and NAFLD (n = 3492; 39 %); COVID-19 plus cirrhosis and HCV (n = 1707; 19 %); COVID-19 plus cirrhosis and AALD (n = 2518; 28 %); COVID-19 plus cirrhosis and HBV (n = 399; 4 %); COVID-19 plus cirrhosis and AIH (n = 303; 3 %); COVID-19 plus cirrhosis and decompensated cirrhosis (n = 5993; 67 %) | No | 30-day death rates increased progressively from 3.9 % in COVID-19-negative plus cirrhotic to 8.9 % in COVID-19-positive plus cirrhotic patients (Univariate analysis: HR 2.37; 95 % CI, 2.18–2.58; P < .01: multivariate analysis: aHR 2.38; 95 % CI 2.18–2.59; P < .01); 90- day death rates increased progressively from 3.9 % in COVID-19-negative plus cirrhotic to 8.9 % in COVID-19-positive plus cirrhotic patients; For decompensated, COVID-19-positive plus cirrhosis had 2.20 aHR of death within 30 days (aHR 2.20; 95 % CI, 2.01-2.42; P < .01) compared to COVID-19 negative plus cirrhotic patients. |
| Bhoori et al. (Apr 2020) [181] | Prospective analysis | Italy | COVID-19 plus long-term (>10 years) liver transplant recipient ((n = 111); COVID-19 plus short-term (<2 years) liver transplant recipient (n = 40); Full immune suppression in COVID-19 plus long-term (>10 years) liver transplant recipient (n = 11;10 %); Full immune suppression in COVID-19 plus short-term (<2 years) liver transplant recipient (n = 28; 70 %) receiving ciclosporin concentration more than 150 ng/mL or tacrolimus concentration more than 5 ng/mL | Yes | COVID-19-related deaths in COVID-19 plus long-term (>10 years) liver transplant recipient (n = 3; 3 %); uneventful progression of COVID-19 in COVID-19 plus short-term (<2 years) liver transplant recipient (n = 3; 7.5 %) |
| Pereira et al. (Apr 2020)[91] | Multicenter study | USA | COVID-19 plus solid organ transplant recipients (n = 90); kidney recipient (n = 46); lung recipient (n = 17); liver recipient (n = 13); heart transplant (n = 9); dual-organ transplants (n = 5) | Yes | Overall mortalities due to COVID-19 (n = 16 (18 %); 24 % hospitalized; 52 % ICU); Severe COVID-19 outcomes in transplant recipients |
| Molnar et al. (SEP 2020)[182] | Multicenter cohort study | USA | COVID-19 plus SOT and non-SOT patients (n = 386); COVID-19 plus SOT patients (n = 98); COVID-19 plus non-SOT patients (n = 288) | Yes | Propensity score for death within 28 days of ICU admission in COVID-19 plus SOT and non-SOT patients (40 % and 43 %, respectively; RR 0.92; 95 % CI: 0.70-1.22); higher risk of acute kidney injury in SOT vs non-SOT patients (37 % vs 27 %; RR 1.34;95 % CI: 0.97-1.85) |
| Polak et al. (Oct 2020)[183] | European liver transplant registry | 28 European countries | COVID-19 plus LT candidate (n = 57); COVID-19 plus LT recipients (n = 272) | Yes | Crude rate of mortality among COVID-19 plus LT candidate (n = 10; 18 %) and COVID-19 plus LT recipients (n = 36; 15 %) |
| Marjot et al. (Jan 2021)[149] | International registry study | 35 countries | COVID-19 plus AIH (n = 70); 86 % immunosuppression; COVID-19 plus non-AIH CLD (n = 862); COVID-19 plus non-CLD (n = 769) | No | Immunosuppression→not an independent risk factor for mortality in COVID-19 plus AIH patients; equal mortality rates in COVID plus AIH vs. COVID-19 plus non-AIH with CLD; higher disease severity risks (hospitalization) in COVID-19 plus AIH compared to COVID-19 with non-CLD. |
COVID-19; coronavirus infectious disease 19, CLD; chronic liver disease, ALD; alcohol-related liver disease, HBV; hepatitis B virus, HCV; hepatitis C virus, HCC; hepatocellular carcinoma, CP-A; Child-Pugh score -A, CP-B; Child-Pugh score -B, CP-C; Child-Pugh score -C, OR; odd ratio, CI; confidence interval, NAFLD; non-alcoholic fatty liver disease, MAFLD; metabolic associated fatty liver disease, AF; advanced fibrosis, CHC; chronic hepatitis C, FLD; fatty liver disease, ICU: intensive care unit, LD; liver disease; AALD; alcohol-associated liver disease, AIH; autoimmune hepatitis, HR; hazard ratio, aHR; adjusted hazard ratio, SOT; solid organ transplantation, LT; liver transplant.