Liver and Bile
Hepatology. 2022;76(1):126–38
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.
DOI: 10.1002/hep.32337