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Temporal trend of mortality in patients with cirrhosis with primary biliary cholangitis and primary sclerosing cholangitis during the COVID-19 pandemic
  1. Xinyuan He1,
  2. Ning Gao1,
  3. Fan Lv2,
  4. Fengping Wu1,
  5. Yi Liu1,
  6. Lamei Li1,
  7. Walid S Ayoub3,4,
  8. Yee Hui Yeo3,
  9. Fanpu Ji1,5,6,7
  1. 1 Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
  2. 2 School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
  3. 3 Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  4. 4 Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
  5. 5 National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
  6. 6 Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi’an, Shaanxi, China
  7. 7 Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi’an, Shaanxi, China
  1. Correspondence to Dr Yee Hui Yeo, Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA; yeehui.yeo{at}; Dr Fanpu Ji, Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710006, China; jifanpu1979{at}

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We read with interest the study by Ampuero et al 1 on the vulnerability of primary biliary cholangitis (PBC) patients to SARS-CoV-2. Their study, conducted on patients from 13 referral hospitals, highlighted a heightened risk of infection and hospitalisation compared with the general population. However, we propose that their patient selection may inadvertently over-represent severe cases, thus introducing selection bias.

Using the CDC WONDER, a database with deidentified death records that included >99% of decedents in the USA, data associated with cirrhosis among adults aged 25 years and above were collected during 1 January 2012–31 December 2021. We estimated the age-standardised mortality rate (per 100 000 persons) using the direct method, referring to the 2000 US Census (standard population). To determine the impact of the pandemic on cirrhosis-related mortality (defined in online supplemental table S1), we conducted a Prophet model to predict mortality rates in 1 March 2020–31 December 2021 based on the 1 January 2012–28 February 2020 trend. Analysis for hepatitis C virus (HCV) decedents started in 2015 to coincide with the availability of new antivirals. The detailed methods were elaborated in online supplemental data file and online supplemental table S2.

Supplemental material


Among 878 601 cirrhosis-related deaths identified from1 January 2012 to 31 December 2021 (online supplemental table S3), there was a significantly increasing trend in cirrhosis-related …

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  • XH and NG contributed equally.

  • YHY and FJ contributed equally.

  • Contributors All authors: data interpretation and approval the manuscript. XH, NG, FL, WA, YHY and FJ: Study design and data analysis. XH, NG and FJ: Drafting of the manuscript. WA and YHY: Critical review of the manuscript. YHY and FJ: Study conception and study supervision.

  • 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 FJ: Speaker: Gilead Sciences, MSD and Ascletis. Consulting/advisory board: Gilead, MSD.

  • Provenance and peer review Not commissioned; externally 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.