Efficacy and safety of COVID-19 vaccination in patients with cirrhosis

BACKGROUND The clinical efficacy and safety of vaccination against novel coronavirus disease 2019(COVID-19)in patients with cirrhosis have not been evaluated yet.AIM To evaluate the clinical efficacy and safety of vaccination against COVID-19 in patients with cirrhosis.METHODS This was a retrospective cohort study of patients with cirrhosis.The first cohort included patients vaccinated with Gam-COVID-Vac(Sputnik V);the second one consisted of unvaccinated controls.RESULTS The study included 89 vaccinated patients and 148 unvaccinated ones.There were 4 cases of COVID-19 in the vaccinated group and 24 cases in the unvaccinated group(P=0.035).No severe cases of COVID-19 were revealed in the vaccinated group,while there were 12 ones in the unvaccinated group(P=0.012)with 10 deaths detected(P=0.012).The vaccine efficacy was 69.5%(95%confidence interval[CI]:18.5%-94.4%)against symptomatic cases of COVID-19,100%(95%CI:25.1%-100.0%)against severe cases,and 100%(95%CI:1.6%-100.0%)against death associated with COVID-19.The efficacy of full vaccination with revaccination against symptomatic cases of COVID-19 was 88.3%(95%CI:48.0%-99.6%).The overall mortality rate was higher in the unvaccinated group than in the vaccinated group(17.1%vs 3.0%;P=0.001).Higher Child-Turcotte-Pugh class cirrhosis(hazard ratio[HR]=4.13,95%CI:1.82-9.35)and higher age(HR=1.08,95%CI:1.04-1.15)were independent predictors of overall mortality,while vaccination had a protective effect(HR=0.09,95%CI:0.01-0.76).There was no significant difference in liver-related mortality(P=0.135)or the incidence of liver decompensation(P=0.077),bleeding esophageal varices(P=0.397),and vascular events(P=0.651)between the two groups of patients.CONCLUSION Vaccination against COVID-19 in patients with cirrhosis is effective and safe.

Gut Microbiota and Cytokine Profile in Cirrhosis

Background and Aims:Gut dysbiosis and abnormal cytokine profiles are common in cirrhosis.This study aimed to evaluate the correlations between them.Methods:In the blood plasma of cirrhosis patients and controls,27 cytokines were examined using a multiplex assay.The plasma levels of nitrites(stable metabolites of the endothelial dysfunction biomarker nitric oxide)and lipopolysaccharide(LPS)were examined.The fecal microbiota was assessed by 16S rRNA gene sequencing.Results:Levels of IL-1b,IL-2,IL-6,IL-13,IP-10,IFN-g,TNF-a,LPS,and nitrites were higher in cirrhosis patients than in controls,while levels of IL-4,IL-7,and PDGF-BB were lower.The LPS level was directly correlated with the levels of IL-1b,IL1-Ra,IL-9,IL-17,PDGF-BB,IL-6,TNF-a,and nitrites.The nitrite level was significantly directly correlated with the levels of TNF-a,GM-CSF,IL-17,and IL-12,and inversely correlated with the IL-7 level.TNF-a levels were directly correlated with ascites severity and the abundance of Negativicutes,Enterobacteriaceae,Veillonellaceae,and Klebsiella,while inversely correlated with the abundance of Firmicutes,Clostridia,and Subdoligranulum.IFN-g levels were directly correlated with the abundance of Bacteroidaceae,Lactobacillaceae,Bacteroides,and Megasphaera,and inversely correlated with the abundance of Verrucomicrobiota,Akkermansiaceae,Coriobacteriaceae,Akkermansia,Collinsella,and Gemella.IL-1b levels were directly correlated with the abundance of Comamonadaceae and Enterobacteriaceae and inversely correlated with the abundance of Marinifilaceae and Dialister.IL-6 levels were directly correlated with the abundance of Enterobacteriaceae,hepatic encephalopathy,and ascites severity,and inversely correlated with the abundance of Peptostreptococcaceae,Streptococcaceae,and Streptococcus.Conclusions:The abundance of harmful gut microbiota taxa and endotoxinemia directly correlates with the levels of proinflammatory cytokines.