Ragesh B Thandassery*, Shakshi Sharma, Mahanazzudin Syed, Abhilash Perisetti

Thandassery et al. J Clin Transl Res 2022; 8(5):7

Published online: September 13, 2022

Abstract

Background and aim: A few recent studies identified cirrhosis as a risk factor for high mortality in patients with Coronavirus disease-19 (COVID-19). Palliative care is less often involved in the management of cirrhosis. We analyzed a global multi-center database to study the risk of mortality and palliative care referrals in patients with COVID-19 and cirrhosis.
Methods: A federated cloud-based network (TriNetX) data from fifty healthcare organizations across the globe was analyzed retrospectively. Patients with COVID-19 aged from 18 years to 90 years were identified between January 20, 2020 and Nov 16, 2020.
Results: A total of 1,969 patients (group A) with COVID-19 and cirrhosis and 169,257 patients with COVID-19 alone (group B) were studied. The two groups had a similar occurrence of other comorbid diseases. In a propensity-matched analysis, the mortality rate in group A (8.9%) was significantly higher than group B (5.6%), hazard ratio (95% confidence interval) for mortality with cirrhosis was 1.59 (1.26 to 1.99) (P = 0.01). The occurrence of palliative care referrals in group A (4.1%) was significantly higher than group B (2.0%), hazard ratio (95% confidence interval) with cirrhosis was 2.02 (1.39 to 2.94) (P = 0.01).
Conclusion: Mortality rate and palliative care referrals were higher in patients with cirrhosis and COVID-19 compared to those with COVID-19 alone. This increased occurrence of palliative care referrals compared to the general trend in cirrhotic patients probably indicates increased awareness of COVID-19 as a life-threatening condition.
Relevance for patients: Cirrhosis should be identified as a high-risk condition that may require palliative care referral in hospitalized patients with COVID-19. Hospital resource utilization and cost-analysis modeling should anticipate the need for palliative care referrals as a significant outcome in patients with cirrhosis who are hospitalized with COVID-19.

DOI: http://dx.doi.org/10.18053/jctres.08.202205.007

Author affiliation

1. Division of Gastroenterology, Department of Medicine, Central Arkansas Veteran Healthcare System, Little Rock, Arkansas, US
2. Division of Gastroenterology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
3. Department of Geriatrics, Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
4. Department of Biomedical Informatics. University of Arkansas for Medical Sciences, Little Rock, Arkansas, US

*Corresponding author
Ragesh B Thandassery
Division of Gastroenterology, Department of Medicine, Central Arkansas Veteran Healthcare System, Little Rock, Arkansas, US
Department of Biomedical Informatics. University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
Tel: +1 501-257-5637
Fax +1 501-257-6417
Email: doc.ragesh@gmail.com

Handling editor:
Michal Heger
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China

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