P1775 - COVID-19 Experience in Patients With Cirrhosis and Clinically Significant Portal Hypertension

Vimal Bodiwala, MD¹, Sarah Maher, MD¹, Ayse Aytaman, MD², James Araujo, MD², Ayesha Zahiruddin, MD^2
1State University of New York Downstate Medical Center, Brooklyn, NY; ²VA New York Harbor Health System, Brooklyn, NY

Introduction: Patients with underlying cirrhosis have increased mortality from Coronavirus disease 2019 (COVID-19) which correlates with their baseline MELD-Na and Child Turcotte Pugh (CTP) scores.^1,2,3

Methods: We performed an institutional review board-approved retrospective review of medical records of all patients with cirrhosis and clinically significant portal hypertension (CSPH) defined by platelet count < 150,000/microL at our institution between 15 March and 15 May of 2020.

Results: Of 119 patients with cirrhosis and CSPH, fifteen (12.6%) tested positive for SARS-CoV-2 (12 by nasopharyngeal PCR (GENEXPERT) within our institution; 3 tested positive at outside institutions per patient report). Among both uninfected patients and patients with SARS-CoV-2 infection, a majority of patients had CTP Class A cirrhosis (66.6% vs. 85.6%; p=0.144) (Table 1). Compared to uninfected patients, patients with SARS-CoV-2 infection were younger (median age 67 vs. 70 years; p= 0.010), less likely to be former smokers (20% vs. 49.3%; p=0.034) and had significantly higher MELD-Na scores (median 15 vs. 9; p= 0.001).


Of the 12 patients diagnosed with SARS-CoV-2 at our hospital, 4 required supplemental oxygen via nasal cannula or nonrebreather mask on an inpatient medical floor, and 3 had severe disease requiring intubation and mechanical ventilation. Three patients died, two of which had preexisting decompensated liver disease (CTP B or C). None of the patients experienced hepatic decompensating events at the time of their diagnosis or within 90 days of diagnosis.

Discussion: Our single center cohort of patients with cirrhosis and CSPH is in line with previous reports of patients with higher MELD-Na scores being at increased risk of SARS-CoV-2 infection and suggests that patients with decompensated liver disease may have increased mortality from COVID-19.^2,3 Compared to previous reports of hepatic decompensation rate of between 37% and 46%,^2,3 a key difference in our experience is that no patient experienced hepatic decompensation at the time of their diagnosis or within 90 days of diagnosis. This difference may be explained by our single center experience and small sample size compared to multicenter international studies of larger cohorts.


References:


< !1. Singh S, et al. Gastroenterology. 2020; 159 (2): 768-71.

< !2. Marjot T, et al. J Hepatol. 2020; S0168-8278 (20): 33667-9.
3. Moon A, et al. J Hepatol. 2020; 73(3): 705-08.

Characteristic	Uninfected (n=104)	SARS-CoV-2 Infection (n=15)	p-Value
Age, years (median [IQR])	70 [65-73.5]	67 [60.5-69.5]	.010
Male	104 (100%)	15 (100%)	N/A
BMI, kg/m2 (median [IQR])	29.5 [26.6-33.4]	31.1 [24.9-36.3]	.689
Race
White	64 (61.5%)	9 (60%)	.901
Black	35 (33.7%)	6 (40%)	.628
Asian	2 (1.9%)	0	N/A
Other	3 (2.88%)	0	N/A
Ethnicity
Hispanic	24 (23.1%)	4 (26.7%)	.759
Smoking Status
Never Smoker	33 (31.7%)	6 (40%)	.523
Former Smoker	51 (49.3%)	3 (20%)	.034
Active Smoker	20 (19.2%)	6 (40%)	.068
Etiology of cirrhosis
Alcohol Dependence	15 (14.4%)	4 (26.67%)	.404
Hepatitis C	44 (42.3%)	6 (40.0%)	.912
Non-alcoholic Steatohepatitis	21 (20.2%)	1 (6.66%)	.365
Hepatitis B	2 (1.9%)	0	N/A
Multifactorial	20 (19.2%)	4 (26.67%)	.743
Other	2 (1.9%)	0	N/A
Baseline MELD-Na score (median [IQR])	9 [8-11.75]	15 [10.5-16.75]	.001
CTP Class
A	89 (85.6%)	10 (66.6%)	.144
B	15 (14.4%)	3 (20.0%)	.859
C	0	2 (13.3%)	N/A
Comorbidities
Diabetes	42 (40.4%)	10 (66.6%)	.101
HgbA1C, % (median [IQR])	7.3 [6.7-8.0]	7.35 [6.6-8.4]	.582
Hypertension	69 (66.3%)	11 (73.3%)	.807
COPD	12 (11.54%)	2 (13.3%)	.821
Asthma	1 (0.96%)	0	N/A
CAD/Heart Failure	35 (33.65%)	7 (46.66%)	.486
Active cancer	1 (0.96%)	0	N/A
Obesity (BMI >30 kg/m2)	45 (43.3%)	8 (53.3%)	.649

Table: Title: Table 1: Characteristics of Patients with Cirrhosis and Clinically Significant Portal Hypertension (CSPH) Based on SARS-CoV-2 Infection.

Abbreviations: IQR, interquartile range; BMI, body mass index; CAD, coronary artery disease; BMI, body mass index; MELD-Na, Model for End-stage Liver Disease; CTP, Child Turcotte Pugh; HgbA1C, hemoglobin A1c; COPD, chronic obstructive pulmonary disease


Disclosures:
Vimal Bodiwala indicated no relevant financial relationships.
Sarah Maher indicated no relevant financial relationships.
Ayse Aytaman indicated no relevant financial relationships.
James Araujo indicated no relevant financial relationships.
Ayesha Zahiruddin indicated no relevant financial relationships.


Vimal Bodiwala, MD¹, Sarah Maher, MD¹, Ayse Aytaman, MD², James Araujo, MD², Ayesha Zahiruddin, MD². P1775 - COVID-19 Experience in Patients With Cirrhosis and Clinically Significant Portal Hypertension, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.