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Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies
BACKGROUND: COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed. OB...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532143/ https://www.ncbi.nlm.nih.gov/pubmed/34675033 http://dx.doi.org/10.1136/bmjgast-2021-000739 |
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author | Middleton, Paul Hsu, Catherine Lythgoe, Mark P |
author_facet | Middleton, Paul Hsu, Catherine Lythgoe, Mark P |
author_sort | Middleton, Paul |
collection | PubMed |
description | BACKGROUND: COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed. OBJECTIVES: To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection. DESIGN/METHOD: PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model. RESULTS: 63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI: 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI: 1.36 to 2.42). CONCLUSION: Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination. |
format | Online Article Text |
id | pubmed-8532143 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-85321432021-10-22 Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies Middleton, Paul Hsu, Catherine Lythgoe, Mark P BMJ Open Gastroenterol Hepatology BACKGROUND: COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed. OBJECTIVES: To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection. DESIGN/METHOD: PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model. RESULTS: 63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI: 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI: 1.36 to 2.42). CONCLUSION: Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination. BMJ Publishing Group 2021-10-21 /pmc/articles/PMC8532143/ /pubmed/34675033 http://dx.doi.org/10.1136/bmjgast-2021-000739 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Hepatology Middleton, Paul Hsu, Catherine Lythgoe, Mark P Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
title | Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
title_full | Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
title_fullStr | Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
title_full_unstemmed | Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
title_short | Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
title_sort | clinical outcomes in covid-19 and cirrhosis: a systematic review and meta-analysis of observational studies |
topic | Hepatology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532143/ https://www.ncbi.nlm.nih.gov/pubmed/34675033 http://dx.doi.org/10.1136/bmjgast-2021-000739 |
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