Study Draws Link Between Cirrhosis and Increased Mortality with COVID-19

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A retrospective analysis of more than 1 million hospitalizations provides insight into the impact of hepatitis C virus infection and cirrhosis on mortality risk in patients hospitalized with COVID-19.

Data from a retrospective analysis of information from the National Inpatient Sample offers clinicians an overview of the risk of mortality associated with COVID-19 among patients with hepatitis C.

Results of the study, which included data from more than 1 million hospitalizations for COVID-19, suggest hepatitis C virus was not directly associated with an increased risk of mortality, but presence of hepatitis C and cirrhosis was associated with an increased risk of mortality.

“While cirrhosis increases mortality in those hospitalized with COVID-19, HCV in the absence of cirrhosis does not appear to be a risk factor for COVID-19 related mortality,” wrote investigators.

Although no longer considered a public health emergency after a declaration on May 5, 2023, from World Health Organization Director-General Tedros Adhanom Ghebreyesus, the COVID-19 pandemic is expected to remain a prominent focus in academic research for the coming decades.2 Now, years removed from the peak of the pandemic and with more comprehensive data, investigators can develop greater insight into the impact of comorbidities on mortality risk among patients with COVID-19.

In the current study, Jose Debes, MD, PhD, MS, associate professor of medicine in the Division of Infectious Diseases and International Medicine at the University of Minnesota, and Spencer Goble, MD, resident physician at the Hennepin County Medical Center, sought to understand whether a history of hepatitis C virus infection was associated with negative outcomes in those hospitalized with COVID-19. With this in mind, the duo designed their research endeavor as an analysis of data recorded during 2020 within the National Inpatient Sample.

For the purpose of analysis, investigators used ICD-10 codes to establish a primary diagnosis of COVID-19 as well as to determine patients with a history of hepatitis C virus infection including those with documented chronic infection, acute infection, and hepatitis C virus carriers. Investigators pointed out their study did not include data related to hepatitis C virus treatment. Outcomes of interest for the study included differences in mortality, length of hospital stay, and total hospital charges among those with and without a history of hepatitis C virus, which investigators assessed using logistic regression with adjustment for age, sex, and Charlson Comorbidity Index.

Overall, investigators identified 1,050,720 adult hospitalizations with a primary diagnosis of COVID-19 during 2020. Of these, 8040 had a secondary diagnosis of hepatitis C virus infection. Initial analysis suggested those with a history of hepatitis C virus were younger (mean age 62.1 years vs 64.8 years; P <.001), more likely to be men (68.2% vs 52.9%, P <.001), Black (35.2% vs 18.3%, P <.001), and had a higher burden of comorbid diseases.

Analysis of outcomes revealed mortality (Odds Ratio [OR], 1.04; 95% Confidence Interval [CI], 0.90-1.22; P = .549) and intubation (OR, 1.14; 95% CI, 0.98-1.33; P=.092) showed an increased trend in those with a positive history for hepatitis C virus after adjustment for confounders, but investigators noted the observed differences were not statistically significant. Additional analysis restricting the hepatitis C virus cohort to those with cirrhosis suggested these patients were at an increased risk of mortality (adjusted OR, 1.42; 95% CI, 1.05-1.91; P=.023). Investigators also called attention to results indicating a history of hepatitis C virus infection was associated with an increased length of stay (P=.04), but not an increase in hospital charges (P=.64).

“Our study suggests that no specific precautions or differential treatment is needed in patients with [hepatitis C virus] without cirrhosis,” wrote investigators.


  1. Goble S, Debes JD. Hepatitis C Virus Infection and COVID-19 Inpatient Mortality. Presented at: AASLD The Liver Meeting, November 10-14, 2023. Accessed November 21, 2023.
  2. Burki T. WHO ends the COVID-19 public health emergency. Lancet Respir Med. 2023;11(7):588. doi:10.1016/S2213-2600(23)00217-5