Research Article

Risk of Severe Illness and Risk Factors of Outcomes of COVID-19 in Hospitalized Patients with Chronic Liver Disease in a Major U. S. Hospital Network

Table 1

Baseline, clinical characteristics, and outcomes of patient with chronic liver disease and a positive test for SARS-CoV-2.

All patients (N = 2,731)Severity of COVID-19Mortality status
Nonsevere (N = 544)Severe (N = 2,187) valueSurvivor (N = 2487)Nonsurvivor (N = 244) value

Age in years, median (IQR)61.3 (45.4–74.1)52.4 (37.3–69.5)62.6 (48.8–75.1)<0.00152.4 (37.3–69.5)62.6 (48.8–75.1)<0.001
Sex, n (%)
Female1403 (51.4)296 (54.4)1107 (50.6)0.111289 (51.8)114 (46.7)0.13
Ethnicity, n (%) hispanic680 (24.9)154 (28.3)526 (24.0)0.04649 (26.1)31 (12.7)<0.001

Race, n (%)
White936 (34.3)158 (29.0)778 (35.6)0.002824 (33.1)112 (45.9)<0.001
Black884 (32.3)192 (35.3)692 (31.6)808 (32.5)76 (31.1)
Asian161 (5.9)23 (4.2)138 (6.3)141 (5.7)20 (8.2)
Other728 (26.6)168 (30.9)560 (25.6)694 (27.9)34 (13.9)

BMI (kg/m 2), n (%)
≤18.570 (2.6)15 (2.7)55 (2.5)<0.00156 (2.2)14 (5.70)<0.001
18.5–24.9565 (20.6)125 (23.0)440 (20.1)489 (19.7)76 (31.1)
25–29.9759 (27.8)181 (38.3)578 (26.4)698 (28.1)61 (25.0)
≥30.01057 (38.7)162 (29.8)895 (40.9)1007 (40.5)50 (20.5)

Smoking status
Never1731 (63.4)362 (66.5)1369 (62.6)0.011621 (65.2)110 (45.1)<0.001
Former565 (20.7)92 (16.9)473 (21.6)496 (19.9)69 (28.3)
Current267 (9.8)66 (12.1)201 (9.2)245 (9.8)22 (9.0)

Liver-related factors, etiology, n (%)
ALD36 (1.3)15 (2.7)21 (1)0.00132 (1.3)4 (1.6)0.64
NAFLD147 (5.4)27 (5.0)120 (5.5)0.63141 (5.7)6 (2.4)0.03
Viral hepatitis480 (17.6)108 (1989)372 (17)0.12451 (18.1)29 (11.9)0.01
Other liver diseases2548 (93.3)502 (92.3)2046 (93.6)0.292314 (93.0)234 (95.9)0.08

Cirrhosis
No cirrhosis2436 (89.2)484 (89.0)1952 (89.3)0.972227 (89.5)209 (85.6)0.16
CC28 (1.0)6 (1.1)22 (1)24 (1.0)4 (1.6)
DC267 (9.8)54 (9.9)213 (9.7)236 (9.5)31 (12.7)
HCC9 (0.3)2 (0.4)7 (0.3)0.865 (0.2)4 (1.6)<0.001

Comorbidities, n (%)
Cardiovascular disease:
CHF521 (19.1)48 (8.8)473 (21.6)<0.001435 (17.5)86 (35.2)<0.001
HT without complications1669 (61.1)289 (53.1)1380 (63.1)<0.0011486 (59.7)183 (75.0)<0.001
HT with complications770 (28.2)109 (20.0)661 (30.2)<0.001659 (26.5)111 (45.5)<0.001

Diabetes:
Diabetes without complications935 (34.2)145 (26.6)790 (36.1)<0.001843 (33.9)92 (37.7)0.23
Diabetes with complications793 (29.0)98 (18.0)695 (31.8)<0.001699 (28.1)94 (38.5)<0.001
Chronic respiratory disease749 (27.4)119 (21.9)630 (28.8)0.001662 (26.6)87 (35.6)0.003
Chronic neurological disease688 (25.2)134 (24.6)554 (25.3)0.74577 (23.2)111 (45.5)<0.001
CKD of any stage490 (17.9)72 (13.2)418 (19.1)0.001411 (16.5)79 (32.4)<0.001
Anemia1088 (39.8)195 (35.8)893 (40.8)0.03939 (37.7)149 (61.1)<0.001
HIV48 (1.7)12 (2.2)36 (1.6)0.3746 (1.8)2 (0.8)0.24
Depression698 (25.5)146 (26.8)552 (25.2)0.44613 (24.6)85 (34.8)<0.001
Hypothyroidism373 (13.6)56 (10.3)317 (14.5)0.01317 (12.7)56 (22.9)<0.001

Malignancies:
Primary cancer285 (10.4)46 (8.4)239 (10.9)0.09241 (9.7)44 (18.0)<0.001
Metastatic cancer182 (6.7)28 (5.1)154 (7.0)0.11152 (6.1)30 (12.3)<0.001

Liver biochemistries:
ALT, median (IQR)29(19–48)24 (16–42)30 (19–49)<0.00129 (19–49)27 (17.5–45)0.20
Normal, n (%)784 (28.7)222 (42.4)562 (25.7)<0.001713 (28.7)71 (29.1)<0.001
1–2 ULN, n (%)867 (31.7)183 (34.9)684 (31.3)793 (31.9)74 (30.3)
>2–5 ULN, n (%)729 (26.7)82 (15.6)647 (29.6)684 (27.5)45 (18.4)
>5 ULN, n (%)314 (11.5)37 (7.1)277 (12.7)262 (10.7)52 (21.3)
AST, median (IQR)36(25–55)28 (21–43)38 (27–57)<0.00135 (25–54)42 (30–69)<0.001
Normal, n (%)1468 (53.7)359 (66.0)1109 (50.1)<0.0011363 (54.8)105 (43.0)<0.001
1–2 ULN, n (%)839 (30.7)99 (18.2)740 (33.8)754 (30.3)85 (34.8
>2–5 ULN, n (%)240 (8.8)36 (6.6)204 (9.3)209 (8.4)31 (12.7)
>5 ULN, n (%)52 (1.9)9 (1.6)43 (2.0)40 (1.6)12 (4.9)
T. Bil, median (IQR)0.5 (0.3–0.6)0.5 (0.3–0.6)0.5 (0.3–0.6)0.350.5 (0.3–0.6)0.5 (0.4–0.9)<0.001
Normal, n (%)1468 (56.5)359 (66.0)1109 (50.7)<0.0012265 (91.1)208 (85.2)<0.001
1–2 ULN, n (%)839 (30.7)99 (18.2)740 (33.8)99 (4.0)26 (10.6)
>2–5 ULN, n (%)240 (8.8)36 (6.6)204 (9.3)19 (0.8)4 (1.6)
>5 ULN, n (%)52 (1.9)9 (1.6)43 (2.0)3 (0.1)2 (0.8)
ALP, median (IQR)78 (61–103)80 (65–108)77 (61–101)0.00777 (61–101)89(65–123)<0.001
Normal, n (%)2241 (82.0)420 (77.2)1821 (83.3)0.222062 (82.9)179 (73.4)<0.001
1–2 ULN, n (%)377 (13.8)88 (16.2)289 (13.2)326 (13.1)51 (20.9)
>2–5 ULN, n (%)54 (2.0)11 (2.0)43 (2.0)43 (1.7)11 (4.5)
>5 ULN, n (%)5 (0.2)1 (0.2)4 (0.2)3 (0.1)2 (0.8)
GGT, median (IQR)117(55–188)119 (116–216)115 (55–170)0.47117 (55–188)116.5 (63–170)0.93

Clinical outcome, no. (%)
Still admitted75 (2.7)11 (2.0)64 (2.9)0.2575 (3.0)0 (0.0)0.006
Discharged alive from the hospital2412 (88.8)533 (98.0)1879 (85.9)<0.0012412 (97.0)0 (0.0)<0.001
Median length of hospital stay (IQR)5.7 (3.0–10.2)2.7 (1.8–4.4)6.4 (3.8–11.8)<0.0015.4 (3.0–9.8)8.2 (3.6–16.5)<0.001
Died in the hospital244 (8.9)0 (0)244 (11.1)<0.0010 (0.0)244 (100)<0.001

Abbreviations: IQR, interquartile range; BMI, body mass index; HT: hypertension; CHF, congestive heart failure; CKD, chronic kidney disease; CC, compensated cirrhosis; DC, decompensated cirrhosis; NAFLD, nonalcoholic fatty liver disease; ALD, alcohol-related liver disease; ALT, alanine aminotransferases; ALP, alkaline phosphatase; GGT: γ-glutamyl transpeptidase; AST: aspartate aminotransferase; T-Bil, total bilirubin; INR, international normalized ratio; BUN, blood urea nitrogen; PT, prothrombin time; CRP: C-reactive protein; LDH: lactate dehydrogenase. Severity of COVID-19 was graded as per the World Health Organization (WHO) interim guidance.