Vascular liver diseases (VLD) are represented mainly by portosinusoidal vascular disease (PSVD), non-cirrhotic splanchnic vein thrombosis (SVT) and Budd Chiari syndrome (BCS). It is unknown whether patients with VLD constitute a high-risk population for complications and greater COVID-19-related mortality from SARS-CoV-2 infection. Our objective was to assess the prevalence and severity of SARS-CoV-2 infection among patients with VLD, as well as to assess its impact on hepatic decompensation and survival.
This is a observational international study analyzing the prevalence and severity of SARS-CoV-2 infection in VLD between March 2020-March 2021 comparing with the general population (GP). Patients from Spain (5 centers, n = 493) and France (1 center, n = 475) were included.
Nine hundred and sixty-eight patients were included: 274 PSVD, 539 SVT and 155 BCS. Among them, 138 (14%) were infected with SARS-CoV-2: 53 PSVD, 77 SVT and 8 BCS. The prevalence of SARS-CoV-2 infection in PSVD (19%) and SVT (14%) was significantly higher than in GP (6.5%, p < 0.05), while it was very similar in BCS (5%). In terms of infection severity, patients with VLD also presented a higher need of hospital admission (14% vs 7.3%, p<0.01), ICU admission (2% vs 0.7%, p< 0.01) and mortality (4% vs 1.5%, p < 0.05) than GP. Previous history of ascites (50% vs 8%, p < 0.05) and post-COVID-19 hepatic decompensation (50% vs 4%, p < 0.05) were associated to COVID-19 mortality.
PSVD and SVT patients could be at higher risk of infection by SARS-CoV-2 and at higher risk of severe COVID-19 disease.

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