Liver and Bile

Hepatology. 2022;76(1):126–38

John BV, Deng Y, Schwartz KB, Taddei TH, Kaplan DE, Martin P, Chao HH, Dahman B

Postvaccination COVID-19 infection is associated with reduced mortality in patients with cirrhosis

Background and aims: Patients develop breakthrough COVID-19 infection despite vaccination. The aim of this study was to identify outcomes in patients with cirrhosis who developed postvaccination COVID-19.
Methods: The authors performed a retrospective cohort study among US veterans with cirrhosis and postvaccination or unvaccinated COVID-19. Patients were considered fully vaccinated if COVID-19 was diagnosed 14 days after the second dose of either the BNT162b2, the 1273-mRNA, or the single-dose Ad.26.COV2.S vaccines and partially vaccinated if COVID-19 was diagnosed 7 days after the first dose of any vaccine but prior to full vaccination. The association of postvaccination COVID-19 with mortality was investigated.
Results: 3242 unvaccinated and 254 postvaccination COVID-19 patients with cirrhosis (82 after full and 172 after partial vaccination) were identified. In a multivariable analysis of a 1:2 propensity-matched cohort including vaccinated (n = 254) and unvaccinated (n = 508) participants, postvaccination COVID-19 was associated with reduced risk of death (adjusted hazard ratio [aHR] = 0.21, 95% confidence interval [CI]: 0.11–0.42). The reduction was observed after both full (aHR = 0.22, 95% CI: 0.08–0.63) and partial (aHR = 0.19, 95% CI: 0.07–0.54) vaccination, following the 1273-mRNA (aHR = 0.12, 95% CI: 0.04–0.37) and BNT162b2 (aHR = 0.27, 95% CI: 0.10–0.71) vaccines and among patients with compensated (aHR = 0.19, 95% CI: 0.08–0.45) and decompensated (aHR = 0.27, 95% CI: 0.08–0.90) cirrhosis. Findings were consistent in a sensitivity analysis restricted to participants who developed COVID-19 after vaccine availability.

Conclusions: Though patients with cirrhosis can develop breakthrough COVID-19 after full or partial vaccination, these infections are associated with reduced mortality.

B.V. John, M.D., Associate Professor of Medicine, University of Miami Miller School of Medicine, Miami VA Health System, Miami, FL, USA,

DOI: 10.1002/hep.32337

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