背景:由于疫苗接种和抗病毒治疗的改善,SARS-CoV-2感染的毒力和严重程度在普通人群中随着时间的推移而降低。肝硬化患者是否发生了类似的趋势尚不清楚。我们使用了国家COVID队列协作(N3C)来描述随着时间的推移的结果。
方法:我们利用N3C3级数据集和未经审查的日期来识别截至2023年11月所有患有和不患有肝硬化的SARS-CoV-2感染的慢性肝病(CLD)患者。我们描述了按感染月观察到的30天病死率(CFR)。我们使用调整后的生存分析来计算与COVID-19大流行开始时的感染相比,按感染月份的相对死亡风险。
结果:我们确定了在3/2020-11/2023之间感染SARS-CoV-2的总共117,811名CLD患者:27,428(23%)肝硬化和90,383(77%)无肝硬化。在整个研究期间观察到的30天CFRs为无肝硬化的CLD患者的1.1%(1,016)和肝硬化的6.3%(1,732)。在整个大流行期间,按感染月份观察到的30天CFR各不相同,自2022年以来呈持续下降趋势。与2020年第二季度(大流行开始时)的感染相比,2023年第3季度,无肝硬化的CLD患者在感染30日时的校正死亡风险为0.20(95CI0.08~0.50),有肝硬化的CLD患者为0.35(95CI0.18~0.69).
结论:在这项N3C研究中,我们发现,观察到的30天CFR逐渐降低为CLD患者和无肝硬化,与普通人群中看到的更广泛的趋势一致。
BACKGROUND: The virulence and severity of SARS-CoV-2 infections have decreased over time in the general population due to vaccinations and improved antiviral treatments. Whether a similar trend has occurred in patients with cirrhosis is unclear. We used the National COVID Cohort Collaborative (N3C) to describe the outcomes over time.
METHODS: We utilized the N3C level 3 data set with uncensored dates to identify all chronic liver disease (CLD) patients with and without cirrhosis who had SARS-CoV-2 infection as of November 2023. We described the observed 30-day case fatality rate (CFR) by month of infection. We used adjusted survival analyses to calculate relative hazard of death by month of infection compared to infection at the onset of the COVID-19 pandemic.
RESULTS: We identified 117,811 total CLD patients infected with SARS-CoV-2 between 3/2020-11/2023: 27,428 (23%) with cirrhosis and 90,383 (77%) without cirrhosis. The observed 30-day CFRs during the entire study period were 1.1% (1,016) for CLD patients without cirrhosis and 6.3% (1,732) with cirrhosis. Observed 30-day CFRs by month of infection varied throughout the pandemic and showed a sustained downward trend since 2022. Compared to infection in Quarter 2 of 2020 (at the beginning of the pandemic), the adjusted hazards of death at 30 days for infection in Quarter 3 of 2023 were 0.20 (95%CI 0.08-0.50) for CLD patients without cirrhosis and 0.35 (95%CI 0.18-0.69) for CLD patients with cirrhosis.
CONCLUSIONS: In this N3C study, we found that the observed 30-day CFR decreased progressively for both CLD patients with and without cirrhosis, consistent with broader trends seen in the general population.