Article Text

Download PDFPDF
Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort
  1. Jasmohan S Bajaj1,2,
  2. Guadalupe Garcia-Tsao3,
  3. Scott W Biggins4,
  4. Patrick S Kamath5,
  5. Florence Wong6,
  6. Sara McGeorge2,
  7. Jawaid Shaw2,
  8. Meredith Pearson4,
  9. Micheal Chew3,
  10. Andrew Fagan2,
  11. Randolph de la Rosa Rodriguez3,
  12. Janelle Worthington5,
  13. Amy Olofson5,
  14. Vanessa Weir7,
  15. Calvin Trisolini7,
  16. Sarah Dwyer7,
  17. K Rajender Reddy7,8
  1. 1 Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
  2. 2 Department of Medicine, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Health Care System, Richmond, Virginia, USA
  3. 3 Department of Medicine, Internal Medicine, Yale University, New Haven, Connecticut, USA
  4. 4 University of Washington, Seattle, Washington, USA
  5. 5 Department of Medicine, Gastroenterology and Hepatology, Mayo Medical School, Rochester, Minnesota, USA
  6. 6 Toronto General Hospital, Toronto, Ontario, Canada
  7. 7 Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  8. 8 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Jasmohan S Bajaj, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, VA 23221, USA; jasmohan{at}


Objective Comorbid conditions are associated with poor prognosis in COVID-19. Registry data show that patients with cirrhosis may be at high risk. However, outcome comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone and cirrhosis alone are lacking. The aim of this study was to perform these comparisons.

Design A multicentre study of inpatients with cirrhosis+COVID-19 compared with age/gender-matched patients with COVID-19 alone and cirrhosis alone was performed. COVID-19 and cirrhosis characteristics, development of organ failures and acute-on-chronic liver failure (ACLF) and mortality (inpatient death+hospice) were compared.

Results 37 patients with cirrhosis+COVID-19 were matched with 108 patients with COVID-19 and 127 patients with cirrhosis from seven sites. Race/ethnicity were similar. Patients with cirrhosis+COVID-19 had higher mortality compared with patients with COVID-19 (30% vs 13%, p=0.03) but not between patients with cirrhosis+COVID-19 and patients with cirrhosis (30% vs 20%, p=0.16). Patients with cirrhosis+COVID-19 versus patients with COVID-19 alone had equivalent respiratory symptoms, chest findings and rates of intensive care unit transfer and ventilation. However, patients with cirrhosis+COVID-19 had worse Charlson Comorbidity Index (CCI 6.5±3.1 vs 3.3±2.5, p<0.001), lower presenting GI symptoms and higher lactate. Patients with cirrhosis alone had higher cirrhosis-related complications, maximum model for end-stage liver disease (MELD) score and lower BiPAP/ventilation requirement compared with patients with cirrhosis+COVID-19, but CCI and ACLF rates were similar. In the entire group, CCI (OR 1.23, 95% CI 1.11 to 1.37, p<0.0001) was the only variable predictive of mortality on multivariable regression.

Conclusions In this multicentre North American contemporaneously enrolled study, age/gender-matched patients with cirrhosis+COVID-19 had similar mortality compared with patients with cirrhosis alone but higher than patients with COVID-19 alone. CCI was the only independent mortality predictor in the entire matched cohort.

  • cirrhosis
  • liver cirrhosis
  • chronic liver disease
  • sepsis
  • infectious disease

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Correction notice This article has been corrected since it published Online First. The author's name, Scott W Biggins, has been corrected.

  • Contributors JSB, GG-T, SB, PSK, FW and KRR conceptualised the project and helped with collection and data visualisation, and drafting and review of the manuscript; SMcG was responsible for the REDCap database. SM, JS, MP, MC, AF, RdRR, JW, AO, CT and SD were involved in data entry.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The protocol was approved by all institutional review boards (ID BAJAJ0015).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.