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SARS-CoV-2 Omicron variant infection was associated with higher morbidity in patients with cirrhosis
  1. Anand V Kulkarni1,
  2. Chandan S Metage2,
  3. Baqar Ali Gora1,
  4. Sowmya Tirumalle1,
  5. Kalyan Rakam1,
  6. Anveshi Satyavadi1,
  7. Mithun Sharma1,
  8. Sameer Shaik1,
  9. Deepika Gujjarlapudi3,
  10. Padaki Nagaraja Rao1,
  11. D Nageshwar Reddy4
  1. 1 Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  2. 2 Department of Pulmonology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  3. 3 Department of Biochemistry, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  4. 4 Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
  1. Correspondence to Dr Anand V Kulkarni, Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana 500032, India; anandvk90{at}

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Dufour et al highlighted that the effect of COVID-19 in patients with cirrhosis is derived from the prevaccination era and suggested that the impact of Omicron infection in patients with cirrhosis needs to be elucidated.1 We agree with the author that previous studies have reported significant morbidity and mortality in patients with cirrhosis infected with SARS CoV-2 in the prevaccination era.2–7 To our knowledge, no studies have assessed the impact of Omicron infection in patients with cirrhosis. Therefore, we aimed to compare the outcomes of Omicron infection among patients with cirrhosis and without cirrhosis.

We retrospectively included non-cirrhotic (NC) patients and patients with cirrhosis from 1 January 2022 to 1 March 2022 diagnosed with Omicron infection. Omicron BA.1 variant was identified based on the S-gene dropout on the reverse transcriptase PCR test. In the absence of S-gene drop-out, Omicron BA.2 variant was confirmed by assessing the presence of Q954H mutation. The primary outcome was to compare the mortality, and the secondary was to compare the other essential outcomes,8 including long COVID-19 effects among both groups (online supplemental figure 1). The severity of COVID-19 was graded based on Indian …

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  • Contributors AK prepared the study protocol, cared for the patients, was involved in data analysis and drafting of the manuscript; CSM helped in preparing the study protocol and data collection and cared for patients; BAG collected the data; ST collected the data and cared for the patients; KR involved in patient care; AS involved in patient care; MS helped with initial drafting of the manuscript; SS helped in data collection; DG provided the laboratory support; PNR critically assessed the protocol and manuscript for accuracy; DNR served as scientific advisor and critically assessed the final manuscript. AK and DNR are the guarantors of the study. All members approved the final draft of the manuscript.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.