A global multicenter propensity-matched analysis of mortality risk and palliative care referral due to cirrhosis in hospitalized patients with COVID-19
Background and aim: A few recent studies identified cirrhosis as a risk factor for high mortality in patients with Coronavirus disease-19 (COVID-19). Palliative care is less often involved in the management of cirrhosis. We analyzed a global multi-center database to study the risk of mortality and palliative care referrals in patients with COVID-19 and cirrhosis.
Methods: A federated cloud-based network (TriNetX) data from fifty healthcare organizations across the globe was analyzed retrospectively. Patients with COVID-19 aged from 18 years to 90 years were identified between January 20, 2020 and Nov 16, 2020.
Results: A total of 1,969 patients (group A) with COVID-19 and cirrhosis and 169,257 patients with COVID-19 alone (group B) were studied. The two groups had a similar occurrence of other comorbid diseases. In a propensity-matched analysis, the mortality rate in group A (8.9%) was significantly higher than group B (5.6%), hazard ratio (95% confidence interval) for mortality with cirrhosis was 1.59 (1.26 to 1.99) (P = 0.01). The occurrence of palliative care referrals in group A (4.1%) was significantly higher than group B (2.0%), hazard ratio (95% confidence interval) with cirrhosis was 2.02 (1.39 to 2.94) (P = 0.01).
Conclusion: Mortality rate and palliative care referrals were higher in patients with cirrhosis and COVID-19 compared to those with COVID-19 alone. This increased occurrence of palliative care referrals compared to the general trend in cirrhotic patients probably indicates increased awareness of COVID-19 as a life-threatening condition.
Relevance for patients: Cirrhosis should be identified as a high-risk condition that may require palliative care referral in hospitalized patients with COVID-19. Hospital resource utilization and cost-analysis modeling should anticipate the need for palliative care referrals as a significant outcome in patients with cirrhosis who are hospitalized with COVID-19.
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