Abstract
BACKGROUND: A multicenter cohort of patients hospitalized with COVID-19 was examined to consider the impact of comorbid liver disease in general, and alcohol-associated liver disease (ALD) in particular, on short-term outcomes. METHODS: Data from patients with COVID-19 hospitalized at 21 participating healthcare systems between February 2020 and January 2022 were examined. The analyses used generalized linear mixed model logistic regression including random intercepts to account for clustering within healthcare systems. RESULTS: Among 145,944 patients hospitalized with COVID-19, 7951 (5.4%) had comorbid liver disease; 1153 (14.5%) had ALD, and 6798 (85.5%) had nonalcohol-associated liver disease (NAALD). The presence of liver disease was associated with increased mortality (adjusted odds ratio [aOR] 3.39, p < 0.001), assisted ventilation (aOR 2.95, p < 0.001), and ICU admission (aOR 2.27, p < 0.001). There was a clear gradient of mortality among the severity of liver disease such that fibrosis < cirrhosis < decompensated cirrhosis. When compared to patients with NAALD, ALD was associated with reduced mortality (aOR 0.36, p < 0.001), assisted ventilation (aOR 0.38, p < 0.001), and ICU admission (aOR 0.56, p < 0.001). On multivariable analysis, liver disease, male gender, increasing age, higher BMI, and former smoking status, but not ALD, were associated with increased mortality with COVID-19. CONCLUSIONS: In this large cohort of hospitalized COVID-19 patients, the presence of liver disease increased the odds of all tested adverse outcomes with a mortality gradient that correlated with the severity of liver disease. When compared to liver disease not related to alcohol, ALD was associated with reduced odds of mortality, assisted ventilation, and ICU admission.