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We read with interest the article by Dufour et al.1 The authors were to be commended for their comprehensive review on the presentations, pathophysiology and prognosis of COVID-19 in patients with chronic liver disease. Notably, the authors included data from multicentre and nationwide cohort studies to suggest decompensated cirrhosis as an independent risk factor for severe COVID-19 and death.1–6
However, while excess death from COVID-19 among patients with cirrhosis is important, the non-COVID-19-related excess death is integral in considering the degree of care disruption and delayed presentation, especially for those before 65 years of age. Thus, using the CDC WONDER website of the US National Vital Statistic System, which includes over 99% of deaths annually, we evaluated the percentage of excess years of potential life loss (YPLL) among individuals with cirrhosis during the pandemic and how much of these excess YPLL were directly versus indirectly related to COVID-19. Details of method are included in the online supplemental file. In brief, we included decedents with cirrhosis listed as one of the causes of death in the death certificate. We estimated cirrhosis-related premature deaths by calculating the YPLL.7 8 We then conducted forecast analysis to estimate the projected YPLL according to the pre-pandemic YPLL. Excess YPLL was defined by the difference between projected and observed YPLLs. Proportion of COVID-19 is …
YZ and YHY contributed equally.
Contributors All authors: Data interpretation and approval the manuscript. YZ, YHY, FL, XH, FJ, MHN: Study design and data analysis. YZ, YHY, JS: Drafting of the manuscript. JDY, WSA, MCO, FJ: Critical review of the manuscript. MHN: Critical revision of the manuscript. FJ, MHN: 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. MHN: Grants: Gilead, Pfizer, Enanta, Vir, Glycotest, National Cancer Institute, B. K. Kee Foundation, Exact Sciences, Helio Health, CurveBio; Consulting or advisory board: Intercept, Gilead, Exact Sciences, Laboratory of Advanced Medicine, Bayer, Eisai, GSK, Novartis.
Provenance and peer review Not commissioned; internally peer reviewed.
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