■患有或不患有肝硬化的慢性肝病(CLD)患者,关于SARS-CoV-2感染不良结局风险的现有数据参差不齐或普适性有限.我们使用了国家COVID队列协作(N3C)数据飞地,统一的电子健康记录(EHR)数据集,有590万全国代表性,多样化,和性别平衡的患者,描述患有SARS-CoV-2的CLD和肝硬化患者的结局。
■我们确定了所有患有和没有肝硬化的慢性肝病患者,他们在数据发布日期5/15/2021中记录了SARS-CoV-2测试。主要结果是30天全因死亡率。生存分析方法用于估计死亡的累积发生率,住院治疗,机械通气,并计算SARS-CoV-2感染的关联,肝硬化的存在,以及人口统计学和临床因素对30天死亡率的影响。
■我们分离出217,143例CLD患者:129,097(59%)无肝硬化和SARS-CoV-2阴性,25,844(12%)无肝硬化和SARS-CoV-2阳性,54,065(25%)肝硬化和SARS-CoV-2阴性,和8137(4%)肝硬化和SARS-CoV-2阳性。在无肝硬化的CLD患者中,SARS-CoV-2阴性患者30天全因死亡率为0.4%,阳性患者为1.8%。在肝硬化CLD患者中,SARS-CoV-2阴性患者30天全因死亡率为4.0%,阳性患者为9.7%。与SARS-CoV-2阴性的人相比,在肝硬化患者中,SARS-CoV-2阳性与30天死亡风险的两倍以上(aHR2.43,95%CI2.23-2.64)相关。与无肝硬化患者相比,在SARS-CoV-2检测阳性的患者中,肝硬化的存在与30天死亡风险的3倍(aHR3.39,95%CI2.96~3.89)相关.年龄(每年AHR1.03,95%CI1.03-1.04)与SARS-CoV-2阳性的肝硬化患者在30天死亡相关。
■在这项对近22万名CLD患者的研究中,我们发现在肝硬化患者中SARS-CoV-2感染与2.43倍的死亡风险相关,感染SARS-CoV-2的CLD患者中肝硬化的存在与3.39倍的死亡风险相关。与以前的研究相比,我们使用具有全国代表性的人,多样化,和性别平衡的数据集使这些发现具有广泛的普遍性。
UNASSIGNED: In patients with chronic liver diseases (CLD) with or without cirrhosis, existing data on the risk of adverse outcomes with SARS-CoV-2 infection have been mixed or have limited generalizability. We used the National COVID Cohort Collaborative (
N3C) Data Enclave, a harmonized electronic health record (EHR) dataset of 5.9 million nationally-representative, diverse, and gender-balanced patients, to describe outcomes in patients with CLD and cirrhosis with SARS-CoV-2.
UNASSIGNED: We identified all chronic liver diseases patients with and without cirrhosis who had SARS-CoV-2 testing documented in the
N3C Data Enclave as of data release date 5/15/2021. The primary outcome was 30-day all-cause mortality. Survival analysis methods were used to estimate cumulative incidences of death, hospitalization, and mechanical ventilation, and to calculate the associations of SARS-CoV-2 infection, presence of cirrhosis, and demographic and clinical factors to 30-day mortality.
UNASSIGNED: We isolated 217,143 patients with CLD: 129,097 (59%) without cirrhosis and SARS-CoV-2 negative, 25,844 (12%) without cirrhosis and SARS-CoV-2 positive, 54,065 (25%) with cirrhosis and SARS-CoV-2 negative, and 8,137 (4%) with cirrhosis and SARS-CoV-2 positive. Among CLD patients without cirrhosis, 30-day all-cause mortality rates were 0.4% in SARS-CoV-2 negative patients and 1.8% in positive patients. Among CLD patients with cirrhosis, 30-day all-cause mortality rates were 4.0% in SARS-CoV-2 negative patients and 9.7% in positive patients.Compared to those who tested SARS-CoV-2 negative, SARS-CoV-2 positivity was associated with more than two-fold (aHR 2.43, 95% CI 2.23-2.64) hazard of death at 30 days among patients with cirrhosis. Compared to patients without cirrhosis, the presence of cirrhosis was associated with a three-fold (aHR 3.39, 95% CI 2.96-3.89) hazard of death at 30 days among patients who tested SARS-CoV-2 positive. Age (aHR 1.03 per year, 95% CI 1.03-1.04) was associated with death at 30 days among patients with cirrhosis who were SARS-CoV-2 positive.
UNASSIGNED: In this study of nearly 220,000 CLD patients, we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.43-times mortality hazard, and the presence of cirrhosis among CLD patients infected with SARS-CoV-2 were associated with 3.39-times mortality hazard. Compared to previous studies, our use of a nationally-representative, diverse, and gender-balanced dataset enables wide generalizability of these findings.