Trends and Outcomes of COVID-19 Hospitalizations Among Patients with Cirrhosis: Insights from United States National Inpatient Sample, 2020–2022

Background: COVID-19 infection has been a major cause of hospitalization and mortality in the United States. Patients with liver cirrhosis may be especially vulnerable to severe outcomes of COVID-19 infection because of immune dysfunction, systemic inflammation, portal hypertension, and reduced physiological reserve. These factors can increase the risk of severe infection, multiorgan complications, and poor inpatient outcomes. Using the 2020–2022 United States National Inpatient Sample, this study evaluates the effect of cirrhosis among adults hospitalized with COVID-19. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) database. Adult hospitalizations with COVID-19 from 2020 to 2022 were included and stratified according to the presence or absence of cirrhosis. Using multivariable logistic regression analyses, we evaluated in-hospital mortality as the primary outcome. Secondary outcomes included the need for mechanical ventilation, septic shock, ARDS, ECMO utilization, acute kidney injury, renal replacement therapy, length of stay, and hospital charges. Results: A total of 5,934,565 hospitalized COVID-19 patients were included, of which 115,170 had concomitant cirrhosis. COVID-19 patients with cirrhosis had a higher in-hospital mortality than those without cirrhosis (16.8% vs. 11.3%; aOR 1.28; 95% CI 1.22–1.32). Patients with liver cirrhosis were also associated with higher odds of invasive mechanical ventilation, vasopressor use, and septic shock. Conclusions: Cirrhosis was independently associated with increased in-hospital mortality and complications including the need for invasive mechanical ventilation and septic shock in adults hospitalized with COVID-19. Although mortality associated with these patients has declined over time, they represent a high-risk group that requires close monitoring.