THE COVID-19 pandemic, caused by SARS-CoV-2, has claimed over 7 million lives worldwide, with France reporting 168,000 deaths. Patients with chronic liver disease (CLD) face particular risks, as pre-existing liver conditions can worsen COVID-19 outcomes. Recent studies have shown that liver test abnormalities during SARS-CoV-2 infection are common, affecting 20–65% of patients, and are linked to more severe disease.
Advanced fibrosis predicts COVID-19 mortality
A French multicentre registry led by the French Liver Society evaluated 1,219 patients with CLD infected by SARS-CoV-2, making it the largest “real-life” cohort to date. The study confirmed that advanced liver fibrosis was the main independent prognostic factor for COVID-19-related short-term mortality, regardless of Child–Pugh score. Age also contributed significantly to risk, while obesity was the only comorbidity independently associated with death in multivariate analysis.
Interestingly, liver transplant recipients did not experience excess mortality, likely due to restored liver function post-transplant. Similarly, patients with autoimmune hepatitis showed no increased risk, highlighting that immunosuppression alone does not appear to worsen COVID-19 outcomes in CLD.
Implications for clinical care and vaccination
The study also emphasised that cytolytic hepatitis occurred in some patients but without acute liver failure, even in severe COVID-19 cases. Alcohol use, MASLD, and primary liver tumours were associated with worse outcomes in univariate analyses, but only advanced fibrosis and age remained significant in multivariate models.
These findings underline the importance of prioritising vaccination for patients with compensated cirrhosis and monitoring those with advanced fibrosis closely during COVID-19 infection. In addition, the registry revealed that reduced ICU access in some cohorts could contribute to higher mortality, emphasising the need for equitable healthcare access for vulnerable CLD populations.
Overall, this registry provides critical insights into how chronic liver disease affects COVID-19 prognosis, demonstrating that while advanced fibrosis significantly increases mortality risk, liver transplant and autoimmune hepatitis patients may not face additional risk. These results support targeted clinical management and reinforce the prioritisation of vaccination and early intervention strategies for patients with high-risk liver conditions.
Reference
Blaise L et al. COVID-19 and chronic liver disease: results from the 1219 patients French registry. Sci Rep. 2025;15(1):34869.
