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SARS-CoV-2 infection is usually asymptomatic in patients with cirrhosis, study reveals

German scientists have recently reported that COVID-19 infection is initially asymptomatic among patients with cirrhosis compared to those without liver fibrosis. Results of the study were published in United European Gastroenterology Journal on Thursday. Researchers Tony Bruns, Jacob Nattermann, and Fabian Geisler set out to determine the extent to which comorbidities contribute to excess COVID-19 mortality in cirrhosis. Researchers report high mortality rates in patients with liver disease and COVID-19 in various international registries.

During their study, the researchers used the multinational Lean European Open Survey on SARS-CoV-2-infected patients (LEOSS) to identify patients with cirrhosis documented between March 2020 and March 2021. During this period, the wild-type and alpha variants predominated.
While examining the documents, the team of scientists compared symptoms, disease progression, and mortality after propensity score matching (PSM) for age, sex, obesity, smoking status, and concomitant diseases. Moreover, they also compared mortality with that of patients with spontaneous bacterial peritonitis (SBP) without SARS-CoV-2 infection which is a common bacterial infection and well-described precipitator of acute-on-chronic liver failure.

“Among 7096 patients with SARS-CoV-2 infection eligible for analysis, 70 (0.99%) had cirrhosis, and all were hospitalised. Case fatality rate in patients with cirrhosis was 31.4 percent with the highest odds of death in patients older than 65 years (43.6% mortality; odds ratio [OR] 4.02; p = 0.018), Child-Pugh class C (57.1%; OR 4.00; p = 0.026), and failure of two or more organs (81.8%; OR 19.93; p = 0.001),” the study revealed.
According to the study, the risk factors for severe COVID-19 which include diabetes, renal disease, and cardiovascular disease were more frequent in patients with cirrhosis.

Before matching, patients with COVID-19 infection and cirrhosis had a higher case fatality rate than those without cirrhosis. In contrast, matched patients were at a similar risk of death. According to the scientists, this highlighted a role of cirrhosis-associated extrahepatic comorbidities and complications.
Cirrhosis is a late stage of liver scarring (fibrosis). According to doctors and health experts, it is caused by various reasons like hepatitis and chronic alcoholism. If this scarring advances further, a liver transplant may be required.

COVID-19 infected patients with cirrhosis have significant extrahepatic comorbidities and they are often asymptomatic in the early stages of infection. Researchers also noted that extrahepatic comorbidities were largely associated with mortality in cirrhosis patients.

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