Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection

Manuel Mendizabal, Ezequiel Ridruejo, Federico Piñero, Margarita Anders, Martín Padilla, Luis G Toro, Aldo Torre, Pedro Montes, Alvaro Urzúa, Esteban Gonzalez Ballerga, María Dolores Silveyra, Douglas Michelato, Javier Díaz, Mirta Peralta, Josefina Pages, Sandro Ruiz García, Isabel Gutierrez Lozano, Yuridia Macias, Daniel Cocozzella, Norberto Chavez-Tapia, Martín Tagle, Alejandra Dominguez, Adriana Varón, Emilia Vera Pozo, Fátima Higuera-de la Tijera, Carla Bustios, Damián Conte, Nataly Escajadillo, Andrés J Gómez, Laura Tenorio, Mauricio Castillo Barradas, Maria Isabel Schinoni, Fernando Bessone, Fernando Contreras, Leyla Nazal, Abel Sanchez, Matías García, Julia Brutti, María Cecilia Cabrera, Godolfino Miranda-Zazueta, German Rojas, Maximo Cattaneo, Graciela Castro-Narro, Fernando Rubinstein, Marcelo O Silva, Manuel Mendizabal, Ezequiel Ridruejo, Federico Piñero, Margarita Anders, Martín Padilla, Luis G Toro, Aldo Torre, Pedro Montes, Alvaro Urzúa, Esteban Gonzalez Ballerga, María Dolores Silveyra, Douglas Michelato, Javier Díaz, Mirta Peralta, Josefina Pages, Sandro Ruiz García, Isabel Gutierrez Lozano, Yuridia Macias, Daniel Cocozzella, Norberto Chavez-Tapia, Martín Tagle, Alejandra Dominguez, Adriana Varón, Emilia Vera Pozo, Fátima Higuera-de la Tijera, Carla Bustios, Damián Conte, Nataly Escajadillo, Andrés J Gómez, Laura Tenorio, Mauricio Castillo Barradas, Maria Isabel Schinoni, Fernando Bessone, Fernando Contreras, Leyla Nazal, Abel Sanchez, Matías García, Julia Brutti, María Cecilia Cabrera, Godolfino Miranda-Zazueta, German Rojas, Maximo Cattaneo, Graciela Castro-Narro, Fernando Rubinstein, Marcelo O Silva

Abstract

Introduction and objectives: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality.

Patients: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves.

Results: Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001).

Conclusions: SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.

Keywords: Acute-on-chronic liver failure; COVID-19; Cirrhosis; Coronavirus; Death; Pandemic.

Copyright © 2021 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.

Figures

Fig. 1
Fig. 1
28-day cumulative survival of patients with and without cirrhosis.
Fig. 2
Fig. 2
Clinical outcomes of SARS-CoV-2 infection in patients with and without cirrhosis.
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) curves and area under the curve (AUC) to determine the score accuracy for CLIF-C, NACSELD, baseline MELD-Na and baseline CTP as predictors of 28-day mortality for patients with SARS-CoV-2 infection and cirrhosis. The AUC were as follows: 0.85 for CLIF-C, 0.75 for NACSELD, 0.69 for MELD-Na and 0.67 for CTP.

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