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.Obje...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-10-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/8/1/e000739.full |
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| _version_ | 1846138126948368384 |
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| author | Paul Middleton Mark P Lythgoe Catherine Hsu |
| author_facet | Paul Middleton Mark P Lythgoe Catherine Hsu |
| author_sort | Paul Middleton |
| collection | DOAJ |
| 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 | Article |
| id | doaj-art-ce272f975c7949d28065c1e009bce97d |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-ce272f975c7949d28065c1e009bce97d2024-12-07T09:40:12ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742021-10-018110.1136/bmjgast-2021-000739Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studiesPaul Middleton0Mark P Lythgoe1Catherine Hsu2IBD Department, St Mark’s Hospital, London, UK1 Department of Surgery and Cancer, Imperial College London, London, UKImperial College Healthcare NHS Trust, London, UKBackground 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.https://bmjopengastro.bmj.com/content/8/1/e000739.full |
| spellingShingle | Paul Middleton Mark P Lythgoe Catherine Hsu Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies BMJ Open Gastroenterology |
| 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 |
| url | https://bmjopengastro.bmj.com/content/8/1/e000739.full |
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