A Longitudinal Cohort Study Using a Modified Child-Pugh Score to Escalate Respiratory Support in COVID-19 Patients — Hubei Province, China, 2020

Background:We explored a phenotype of liver dysfunction based on modified Child-Pugh (MCP) with coronavirus disease 2019 (COVID-19) and evaluated its relationship with escalation of respiratory support and survival. Methods: This was a retrospective cohort study involving COVID-19 in-patients at the Wuhan Jinyintan Hospital. This study was performed between January 24, 2020 and March 31, 2020. Escalation of respiratory support and survival were evaluated. Furthermore, the trajectory of liver function was delineated considering the risk of escalation of respiratory support and survival using multilevel logistic regression. Results:A total of 298 patients were enrolled in this study. A higher proportion of patients with MCP-B on admission exhibited an escalated respiratory support (26 of 55; 47.3%) when compared to patients with MCP-A (9 of 62; 14.5%), indicating that MCP-B was strongly associated with escalation of respiratory support [adjusted hazard ratio (HR): 4.530; 95% confidence interval (CI): 2.060–9.970; P<0.001]. Among the patients on escalated respiratory support, 5 (55.6% of 9) patients with MCP-A died compared to 10 (38.5% of 26) of the patients with MCP-B. Patients with a history of liver disease had a higher mortality risk (adjusted HR: 7.830; 95% CI: 1.260-48.420). Conclusion:MCP is efficient at stratifying liver dysfunction levels in COVID-19 patients and is strongly associated with escalation of respiratory support.