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Multicenter Study
. 2024 Nov 18;24(1):1315.
doi: 10.1186/s12879-024-10223-4.

Analyzing prognosis and comparing predictive scoring systems for mortality of COVID-19 patients with liver cirrhosis: a multicenter retrospective study

Shou-Yen Chen  1   2 , Chip-Jin Ng  1 , Yan-Bo Huang  1 , Hsiang-Yun Lo  3
Affiliations
Multicenter Study

Analyzing prognosis and comparing predictive scoring systems for mortality of COVID-19 patients with liver cirrhosis: a multicenter retrospective study

Shou-Yen Chen et al. BMC Infect Dis. .

Abstract

Background: Limited research suggested that liver cirrhosis is an independent risk factor for severe COVID-19, leading to higher hospitalization and mortality rates. This study aimed to identify the prognostic factors and validate scoring systems for predicting mortality in COVID-19 patients with liver cirrhosis.

Methods: This retrospective cohort study extracted electronic health records of patients with COVID-19 who visited the emergency department between April 2021 and September 2022. Adult COVID-19 patients with liver cirrhosis were included, excluding those aged < 18 years and who did not require hospitalization. The primary outcome was in-hospital mortality. The effectiveness of the scoring systems were analyzed for COVID-19 in-house mortality prediction.

Results: A total of 1,368 adult COVID-19 patients with liver cirrhosis were included in this study. Compared with the survival group, the non-survival group had lower vital signs such as systolic blood pressure and blood oxygen saturation, higher levels of white blood cells, creatinine, bilirubin, and C-reactive protein, and longer prothrombin time. Higher rates of intubation, oxygen use, and dexamethasone use were observed in the non-survivor group. The WHO ordinal scale, MELD, and MELD-Na scores showed good predictive ability for in-hospital mortality.

Conclusions: The WHO ordinal scale showed the best performance in predicting mortality in patients with cirrhosis and COVID-19. MELD and MELD-Na scores were also found good performance for mortality prediction. Coagulation function, intubation, and dexamethasone administration were the most significant prognostic factors.

Keywords: COVID-19; Liver cirrhosis; MELD score; MELD-Na score; Mortality; WHO ordinal scale.

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Conflict of interest statement

Declarations Human ethics approval The study was approved by the institutional review board of the Chang-Gung Memorial hospital, Taiwan (IRB no. 202301643B0). This is a retrospective study conducted from de-identified database and informed consent of participation is waived by the Institutional Review Board of CGMH, Taiwan. Consent to participate This is a retrospective study conducted from de-identified database and informed consent of participation is waived by the Institutional Review Board of CGMH, Taiwan (IRB no. 202301643B0). Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patient selection
Fig. 2
Fig. 2
The ROC curves and AUCs of different scoring systems including MELD score, MELD-Na score, WHO ordinal severity scale, inflammation risk categories for mortality prediction in COVID-19 patients with liver cirrhosis
See this image and copyright information in PMC

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