TABLE 2.
Characteristics of included studies on antibody response of SARS-CoV-2 vaccines (Global, 2022–2024).
| Study | Country | Study design | Patients with liver disease (% with cirrhosis) | Age (years) | Controls | Vaccine (number of vaccinated patients, %), dose | Follow-up time (days) after full-course vaccination | Seropositivity rates |
|---|---|---|---|---|---|---|---|---|
| Wang, J. et al. 2021 [19] | China | Prospective cohort, multi-center study | 381 with NAFLD (0% with cirrhosis) | Median 39.0 (IQR 33.0–48.0) | — | Inactivated (BBIBP-CorV, 381, 100%), 2 doses | At least 14, median 39.0 (IQR, 35.0–50.0) | Neutralizing antibody, 95.5% |
| Thuluvath et al. [20] | United States | Prospective cohort study | 171 with CLD (46.2% with cirrhosis, 10 decompensated) | Mean 62.0 | — | mRNA (Moderna, 77, 45.0%; Pfizer, 80, 46.8%), 2 doses; Viral vector (Johnson & Johnson, 14, 8.2%), 1 dose | At least 28, mean 40.8 | Anti-SARS-CoV-2 spike antibody, 95.9% |
| Ruether et al. [21] | Germany | Prospective cohort study | 48 with CLD (100% with cirrhosis, 33.3% Child-Pugh class A, 37.5% Child-Pugh class B; 29.2% Child-Pugh class C) | Mean 53.8 (SD 9.5) | 52 healthy adults matched by age and vaccination regimen | mRNA (Pfizer, 38, 79.2%; Moderna, 6, 12.4%), 2 doses; Viral vector (AZD1222, 1, 2.1%), 2 doses; AZD1222+mRNA (3, 6.3%), 2 doses | At least 10, median 28 (IQR, 21–41) | Anti-spike antibody 98% in patients and 100% in healthy controls; Anti-S RBD antibody 94% in patients and 100% in healthy controls |
| Xiang et al. [18] | China | Cross-sectional study | 149 with CHB (6.7% with compensated cirrhosis) | Median 41.0 (IQR 33.0–49.0) | — | Inactivated (BBIBP-CorV, CoronaVac, or WIBP-CorV, 149, 100%), 2 doses | At least 14, median 33 (IQR 24–48) | Anti-S-RBD IgG, 87.25%; neutralizing antibody 74.5% |
| Ai et al. [27] | China | Prospective cohort, multi-center study | 437 with CLD (35.0% with cirrhosis, 123 compensated cirrhosis, 30 decompensated) | Median 47.0 (IQR 38.0–56.0) | 144 healthy controls, age median 35.0 (IQR 28.5–41.5) | Inactivated (CoronaVac, BBIBP-CorV or WIBP-CorV, 437, 100%), 2 doses | At least 14 | Neutralizing antibody 77.3% in patients and 90.3% in healthy controls |
| He et al. [24] | China | Cross-sectional study | 362 with CHB (13.3% with cirrhosis) | Median 45.0 (Range 19.0–78.0) | 87 healthy adults matched by age, gender and BMI. | Inactivated (BBIBP-CorV/CoronaVac, 362, 100%), 2 doses | At least 21 (Range 21–105) | Anti-spike IgG 97.8% in patients and 100.0% in controls; Anti-RBD IgG 98.3% in patients and 100% in controls; Neutralizing antibody 72.6% in patients and 77.4% in controls |
| Calleri et al. [25] | Italy | Prospective cohort study | 89 with CLD (83.1% with cirrhosis) | Median 56.0 (IQR 50.0–62.0) | 30 healthy controls, median age 55.0 (IQR 46.0–59.0) | mRNA (Pfizer, 83, 93.3%; Moderna 6, 6.7%), 88.8% completed 2 doses | Median 23 (IQR 14–42) | Anti-spike IgG 94.9% in patients and 100% in controls |
| Bakasis et al. 2022 [26] | Greece | Prospective cohort study | 87 with CLD [43.7% with cirrhosis, MELD: median 9 (IQR 6–25)] | Median 67.0 (Range 27.0–86.0) | 40 healthy controls matched by age and gender | mRNA (Pfizer, 81, 93.1%; Moderna, 6, 6.9%), 2 doses | 1 month | Anti-spike IgG 92.0% in patients and 100% in controls; Neutralizing antibody 89.7% in patients and 100% in controls |
| Al-Dury et al. [45] | Sweden | Prospective cohort study | 48 with cirrhosis (100% with cirrhosis, 31 Child-Pugh A; 15 Child-Pugh B; 2 Child-Pugh C) | Median 63.5 (26–76) | 39 healthy controls 60 (25–86) | mRNA (Moderna, 4, 8%; Pfizer-BioNTech, 44, 92%), 2 dose | 6 months | Anti-RBD IgG 98% in patients and 100% in controls |
| Biliotti et al. [44] | Italy | Prospective, single-center, observational study | 149 cirrhotic patients (100% with cirrhosis, 133 Child-Pugh A, 16 Child-Pugh B/C) | Median 60 (55–64) | 149 age and sex-matched healthcare workers | All cirrhotic patients: mRNA-1273 vaccine (Moderna); HCWs received the COVID-19 BNT162b2 vaccine (Pfizer-BioNTech) in 147 cases (98.7%) and the mRNA-1273 vaccine (Moderna) in 2 cases (1.3%) | 1 month | anti-S antibodies 100% in cirrhotic patients and HCWs |
| Chen et al. [43] | China | Prospective observational study | 84 AILD (22.6% with cirrhosis) | Median 54.9 (49.3–60.8) | 68 healthcare workers | Inactivated (BBIBP-CorV or Corona-Vac, 84, 100%), 2 doses | 1 month (T1), 3 months (T2) and 6 months (T3) | Anti-RBD IgG 90% in patients and 100% in controls; Neutralizing antibody 90% in patients and 100% in controls |
| Chen et al. [42] | China | Prospective observational study | 192 severe liver disease (66% with cirrhosis) | Median 53 (IQR 47–59) | 142 healthy controls and age median 48 (IQR 33–60) | Inactivated (BBIBP-CorV, 55, 29%; CoronaVac, 127, 66%; BBIBP-CorV + CoronaVac, 10, 5%),2 doses | At least 21 days | Anti-RBD IgG 98.4% in patients and 100% in controls; Neutralizing antibody 57.8% in patients and 76.1% in controls |
| Duengelhoef et al. [41] | Germany | Prospective observational cohort study | 112 consecutive patients with AIH (35% with cirrhosis) and 144 consecutive patients with cholestatic liver disease (17% with cirrhosis) | AIH 53 (17); PBC/PSC 52 (15) | 95 healthy controls age 51 (8) | mRNA (BNT162b2; BioNTech SE/Pfizer or mRNA‐1273; Moderna Biotech); Viral vector vaccine (AZD1222; AstraZeneca). 2 doses | >2 weeks | Anti-spike antibody 98.2% in patients and 100% in healthy controls; Anti-RBD IgG 99.5% in patients and 100% in controls |
| Goel et al. [40] | India | Prospective observational cohort study | 131 cirrhotic patients (61.1% with decompensated cirrhosis) | Median 50 (IQR 43–58) | — | Viral vector vaccine (AZD1222; AstraZeneca). 2 doses | 4 weeks | Anti-spike antibody 99.2%% in patients; Neutralizing antibody 84% in patients |
| Kulkarni et al. [38] | India | Single-center prospective study | 50 non-cirrhosis CLD and 113 Cirrhosis (69%) | NCCLD:49.34 ± 10.48; Cirrhosis: 52.42 ± 9.93 | 60 healthy controls age 51.2 ± 8.75 | Viral vector vaccine (Covishield, 124, 76.07%); inactivated vaccines (Covaxin, 39, 23.93%), 2 dose | 3 months | Anti-spike antibody 84.05% in patients and 91.7% in healthy controls |
| Li et al. [36] | China | Cross-sectional study with longitudinal follow-up | 137 patients with liver dysfunction (47.5% with cirrhosis) | Mean 50.2 | 134 healthy controls and age mean 42.6 | Inactivated:113, 82.5%, 2 doses; RBD-subunit recombinant: 24, 17.5%, 3 doses | At least 30 days | Neutralizing antibody 95.0%% in patients and 96.0% in healthy controls |
| Li et al. [36] | China | Prospective observational study | 76 with autoimmune liver disease (26.3% with cirrhosis) | Median 54.0 (IQR 48.8–60.2) | 136 healthy controls age median52.0 (IQR 33.0–62.2) | Inactivated (BBIBP-CorV: 21, 27.6%; CoronaVac: 49, 64.5%; BBIBP-CorV and CoronaVac: 6, 7.9%), 2, doses | At least 21 days | Anti-RBD IgG 97.4% in patients and 100% in controls; Neutralizing antibody 63.2% in patients and 84.6% in healthy controls |
| Liu et al. [34] | China | Prospective observational study | 237 CLD (22.36% with cirrhosis) | Mean 47.01 (12.00) | 170 healthy controls (HCs) of similar age and post-vaccination days | Inactivated (BBIBP-CorV; CoronaVac; WIBP-CorV) | At least 120 days | Anti-RBD IgG 87.34% in patients and 93.75% in controls; Neutralizing antibody 72.73%% in patients and 100%% in healthy controls |
| Singh et al. 2023 [33] | India | Retrospective study | 88 Cirrhosis (15 CTP A, 71 CTP B and 2 CTP C) | Mean 53.3 ± 10.08 | — | Viral vector (ChAdOx1-nCOV, 88, 100%), 2 doses | 39 (23–76) days | Anti-spike antibody 92.05% in patients |
| Ti et al. [32] | China | Retrospective and prospective epidemiological research | 153 patients with CHB (0% with cirrhosis) | 21∼68 (43.32 ± 12.65) | — | Inactivated vaccine, 153, 100%, 2 doses | At least 3 months | Neutralizing antibody 45.50% in patients |
| Willauer et al. [31] | United States | Retrospective study | 24 CLD (29% with cirrhosis) | Mean 61.0 ± 9.0 | 9 healthy controls and age 51.0 ± 14.5 | mRNA (Pfizer/BioNTech (BNT162b2), 13 54%; Moderna (mRNA-1273) 11 46%), 2 doses | 31 days (23–103) | Anti-spike antibody 95% in patients and 95.6% in healthy controls; Neutralizing antibody 95% in patients and 100% in healthy controls |
| Willuweit et al. [30] | Germany | Prospective observational study | 110 Cirrhosis (69% Child A, 28% Child B and 3% Child C) | Median 55(IQR 45–66) | 80 HCWs and age median 54 (IQR 45–59) | mRNA (BNT162b2 (Pfizer-BioNTech) 100%), 2 doses | 69 days (43–106) | Anti-spike antibody 96% in patients and 99% in healthy controls |
| Wu et al. [29] | China | Prospective observational study | 200 CHB (6% with cirrhosis) | Mean 47.39 ± 13.60 | — | Inactivated (CoronaVac,109,2 doses); Viral vector (ZF2001, 91, 3 doses) | 2 weeks | Neutralizing antibody 86.1%% in patients |
| Yang et al. 2023 [28] | China | Prospective multicenter study | 261 chronic liver disease (79 compensated advanced CLD and 33 decompensated advanced CLD) | Non-ACLD: 38.0 (34.0, 47.0); CACLD: 55.0 (48.0, 59.0); DACLD: 54.0 (48.0, 59.0) | 106 healthy controls and age median 46.0 (IQR 36.0, 54.8) | Inactivated (CoronaVac or BBIBP-CorV, 100%), 3, doses | 6 months | Neutralizing antibody 73.18% in patients and 79.2% in healthy controls; Anti-spike antibody 77.39% in patients and 82.1% in healthy controls |