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In EClinicalMedicine

Background : Scientific evidence is lacking regarding the risk of patients with chronic liver disease (CLD) for COVID-19, and how these risks are affected by age, gender and race.

Methods : We performed a case-control study of electronic health records of 62.2 million patients (age >18 years) in the US up to October 1st, 2020, including 1,034,270 patients with CLD, 16,530 with COVID-19, and 820 with both COVID-19 and CLD. We assessed the risk, disparities, and outcomes of COVID-19 in patients with six major CLDs.

Findings : Patients with a recent medical encounter for CLD were at significantly increased risk for COVID-19 compared with patients without CLD, with the strongest effect in patients with chronic non-alcoholic liver disease [adjusted odd ratio (AOR)=13.11, 95% CI: 12.49-13.76, p < 0.001] and non-alcoholic cirrhosis (AOR=11.53, 95% CI: 10.69-12.43, p < 0.001), followed by chronic hepatitis C (AOR=8.93, 95% CI:8.25-9.66, p < 0.001), alcoholic liver damage (AOR=7.05, 95% CI:6.30-7.88, p < 0.001), alcoholic liver cirrhosis (AOR=7.00, 95% CI:6.15-7.97, p < 0.001) and chronic hepatitis B (AOR=4.37, 95% CI:3.35-5.69, p < 0.001). African Americans with CLD were twice more likely to develop COVID-19 than Caucasians. Patients with COVID-19 and a recent encounter for CLD had a death rate of 10.3% (vs. 5.5% among COVID-19 patients without CLD, p < 0.001) and a hospitalization rate of 41.0% (vs. 23.9% among COVID-19 patients without CLD, p < 0.001).

Interpretation : Patients with CLD, especially African Americans, were at increased risk for COVID-19, highlighting the need to protect these patients from exposure to virus infection.

Funding : National Institutes of Health (AG057557, AG061388, AG062272, 1UL1TR002548-01), American Cancer Society (RSG-16-049-01-MPC).

Wang QuanQiu, Davis Pamela B, Xu Rong


Alcoholic cirrhosis, Alcoholic liver damage, COVID-19, Chronic hepatitis B, Chronic hepatitis C, Chronic liver disease, Chronic nonalcoholic liver disease, Non-alcoholic cirrhosis, Patient electronic health records, SARS-CoV-2