{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:40:54Z","timestamp":1760233254439,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Patients with cirrhosis are vulnerable to hepatic decompensation events and death following COVID-19 infection. Therefore, primary vaccination with COVID-19 vaccines is fundamental to reducing the risk of COVID-19 related deaths in patients with cirrhosis. However, limited data are available about the effectiveness of mRNA vaccines compared to other vaccines. The aim of our study was to investigate the efficacy of mRNA vaccines versus other vaccines in cirrhosis. In this retrospective study, we compared clinical characteristics and vaccine effectiveness of 399 COVID-19 patients without cirrhosis (GROUP A) to 52 COVID-19 patients with cirrhosis (GROUP B). 54 hospitalised cirrhosis controls without COVID-19 (GROUP C) were randomly sampled 1:1 and matched by gender and age. Of the cirrhosis cases, we found no difference (p = 0.76) in mortality rates in controls without COVID-19 (11.8%) compared to those with COVID-19 (9.6%). However, COVID-19 patients with cirrhosis were associated with higher rates of worsening hepatic encephalopathy, ascites and esophageal varices. Patients with cirrhosis receiving mRNA vaccines had significantly better survival rates compared to viral vector or inactivated vaccines. Primary vaccination with the BNT162b2 vaccine was the most effective in preventing acute hepatic decompensating events, COVID-19 infection requiring hospital admission and in-hospital mortality.<\/jats:p>","DOI":"10.3390\/vaccines11010050","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T04:58:01Z","timestamp":1672117081000},"page":"50","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of COVID-19 Vaccination with mRNA Vaccines for Patients with Cirrhosis in Hungary: Multicentre Matched Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6034-6669","authenticated-orcid":false,"given":"B\u00e1lint","family":"Dr\u00e1cz","sequence":"first","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-3187","authenticated-orcid":false,"given":"Veronika","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Istv\u00e1n","family":"Tak\u00e1cs","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krisztina","family":"Hagym\u00e1si","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elek","family":"Dinya","sequence":"additional","affiliation":[{"name":"Digital Health Department, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e1l","family":"Miheller","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"Szij\u00e1rt\u00f3","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8567-7947","authenticated-orcid":false,"given":"Kl\u00e1ra","family":"Werling","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,26]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Predictors of COVID-19 severity: A literature review","volume":"31","author":"Aghagoli","year":"2021","journal-title":"Rev. Med. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jhep.2020.09.024","article-title":"Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study","volume":"74","author":"Marjot","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.jhep.2022.07.008","article-title":"Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper","volume":"77","author":"Marjot","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1007\/s12072-020-10072-8","article-title":"Pre-existing liver disease is associated with poor outcome in patients with SARS-CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)","volume":"14","author":"Sarin","year":"2020","journal-title":"Hepatol. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.jhep.2020.06.001","article-title":"High rates of 30-day mortality in patients with cirrhosis and COVID-19","volume":"73","author":"Iavarone","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/j.cgh.2020.09.027","article-title":"Predictors of Outcomes of COVID-19 in Patients With Chronic Liver Disease: US Multi-center Study","volume":"19","author":"Kim","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1136\/gutjnl-2020-322118","article-title":"Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: Multicentre matched cohort","volume":"70","author":"Bajaj","year":"2021","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1038\/s41575-021-00426-4","article-title":"COVID-19 and liver disease: Mechanistic and clinical perspectives","volume":"18","author":"Marjot","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"doi-asserted-by":"crossref","unstructured":"Tenforde, M.W., Patel, M.M., Ginde, A.A., Douin, D.J., Talbot, H.K., Casey, J.D., Mohr, N.M., Zepeski, A., Gaglani, M., and McNeal, T. (2021). Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing COVID-19 Hospitalizations in the United States. medRxiv.","key":"ref_9","DOI":"10.1101\/2021.07.08.21259776"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/hep.32337","article-title":"Postvaccination COVID-19 infection is associated with reduced mortality in patients with cirrhosis","volume":"76","author":"John","year":"2022","journal-title":"Hepatology"},{"doi-asserted-by":"crossref","unstructured":"M\u00fcller, V., Polivka, L., Valyi-Nagy, I., Nagy, A., Szekanecz, Z., Bogos, K., Vago, H., Kamondi, A., Fekete, F., and Szlavik, J. (2022). Booster Vaccination Decreases 28-Day All-Cause Mortality of the Elderly Hospitalized Due to SARS-CoV-2 Delta Variant. Vaccines, 10.","key":"ref_11","DOI":"10.3390\/vaccines10070986"},{"doi-asserted-by":"crossref","unstructured":"Bakasis, A.D., Bitzogli, K., Mouziouras, D., Pouliakis, A., Roumpoutsou, M., Goules, A.V., and Androutsakos, T. (2022). Antibody Responses after SARS-CoV-2 Vaccination in Patients with Liver Diseases. Viruses, 14.","key":"ref_12","DOI":"10.3390\/v14020207"},{"doi-asserted-by":"crossref","unstructured":"Willuweit, K., Frey, A., Passenberg, M., Korth, J., Saka, N., Anastasiou, O.E., M\u00f6hlendick, B., Sch\u00fctte, A., Schmidt, H., and Rashidi-Alavijeh, J. (2022). Patients with Liver Cirrhosis Show High Immunogenicity upon COVID-19 Vaccination but Develop Premature Deterioration of Antibody Titers. Vaccines, 10.","key":"ref_13","DOI":"10.3390\/vaccines10030377"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.cmi.2021.11.011","article-title":"Nationwide effectiveness of five SARS-CoV-2 vaccines in Hungary-the HUN-VE study","volume":"28","author":"Kiss","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"unstructured":"World Health Organization (2022, November 01). Laboratory Testing for Coronavirus Disease (COVID-19) in Suspected Human Cases: Interim Guidance, 19 March 2020. World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/331501.","key":"ref_15"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"05031","DOI":"10.7189\/jogh.12.05031","article-title":"Long-term survival benefit of male and multimorbid COVID-19 patients with 5-day remdesivir treatment","volume":"12","author":"Polivka","year":"2022","journal-title":"J. Glob. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/bjs.1800600817","article-title":"Transection of the oesophagus for bleeding oesophageal varices","volume":"60","author":"Pugh","year":"1973","journal-title":"Br. J. Surg."},{"key":"ref_18","first-page":"93","article-title":"Natural history of grade 1 ascites in patients with liver cirrhosis","volume":"34","author":"Theodorakopoulos","year":"2021","journal-title":"Ann. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40265-018-1018-z","article-title":"Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles","volume":"79","author":"Weissenborn","year":"2019","journal-title":"Drugs"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.jhep.2014.11.012","article-title":"The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure","volume":"62","author":"Jalan","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","author":"Moreau","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1002\/hep.29773","article-title":"NACSELD acute-on-chronic liver failure (NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis","volume":"67","author":"Reddy","year":"2018","journal-title":"Hepatology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1002\/hep4.1853","article-title":"SARS-CoV-2 Infections Among Patients With Liver Disease and Liver Transplantation Who Received COVID-19 Vaccination","volume":"6","author":"Moon","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1053\/j.gastro.2020.04.064","article-title":"Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Among Patients With Preexisting Liver Disease in the United States: A Multicenter Research Network Study","volume":"159","author":"Singh","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1053\/j.gastro.2021.07.010","article-title":"Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study","volume":"161","author":"Ge","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s12072-020-10077-3","article-title":"Liver injury in remdesivir-treated COVID-19 patients","volume":"14","author":"Zampino","year":"2020","journal-title":"Hepatol. Int."},{"doi-asserted-by":"crossref","unstructured":"Teschke, R., M\u00e9ndez-S\u00e1nchez, N., and Eickhoff, A. (2022). Liver Injury in COVID-19 Patients with Drugs as Causatives: A Systematic Review of 996 DILI Cases Published 2020\/2021 Based on RUCAM as Causality Assessment Method. Int. J. Mol. Sci., 23.","key":"ref_27","DOI":"10.3390\/ijms23094828"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jceh.2020.12.006","article-title":"Effect of COVID-19 on Pre-existing Liver disease: What Hepatologist Should Know?","volume":"11","author":"Sharma","year":"2021","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"799338","DOI":"10.3389\/fphar.2022.799338","article-title":"Association Between Drug Treatments and the Incidence of Liver Injury in Hospitalized Patients With COVID-19","volume":"13","author":"Gao","year":"2022","journal-title":"Front. Pharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1182\/blood.2021012248","article-title":"COVID-19 convalescent plasma","volume":"140","author":"Tobian","year":"2022","journal-title":"Blood"},{"doi-asserted-by":"crossref","unstructured":"Dr\u00e1cz, B., Czompa, D., M\u00fcllner, K., Hagym\u00e1si, K., Miheller, P., Sz\u00e9kely, H., Papp, V., Horv\u00e1th, M., Hritz, I., and Szij\u00e1rt\u00f3, A. (2022). The Elevated De Ritis Ratio on Admission Is Independently Associated with Mortality in COVID-19 Patients. Viruses, 14.","key":"ref_31","DOI":"10.21203\/rs.3.rs-1333042\/v1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/j.dld.2022.07.007","article-title":"COVID-19 and alcohol associated liver disease","volume":"54","author":"Curtis","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis","volume":"69","author":"Angeli","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.jhep.2018.11.015","article-title":"Influenza virus infection as precipitating event of acute-on-chronic liver failure","volume":"70","author":"Ciesek","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1136\/gutjnl-2017-314641","article-title":"Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure","volume":"67","author":"Wu","year":"2018","journal-title":"Gut"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/lt.25981","article-title":"Cirrhosis Is Associated With High Mortality and Readmissions Over 90 Days Regardless of COVID-19: A Multicenter Cohort","volume":"27","author":"Bajaj","year":"2021","journal-title":"Liver Transpl."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"22777","DOI":"10.1038\/s41598-021-02321-z","article-title":"Comparing the clinical efficacy of COVID-19 vaccines: A systematic review and network meta-analysis","volume":"11","author":"Rotshild","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"549","DOI":"10.15585\/mmwr.mm7115e2","article-title":"Effectiveness of COVID-19 mRNA Vaccination in Preventing COVID-19-Associated Hospitalization Among Adults with Previous SARS-CoV-2 Infection-United States, June 2021-February 2022","volume":"71","author":"Plumb","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1056\/NEJMoa2027906","article-title":"Safety and Immunogenicity of Two RNA-Based COVID-19 Vaccine Candidates","volume":"383","author":"Walsh","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1002\/hep.31751","article-title":"American Association for the Study of Liver Diseases Expert Panel Consensus Statement: Vaccines to Prevent Coronavirus Disease 2019 Infection in Patients With Liver Disease","volume":"74","author":"Fix","year":"2021","journal-title":"Hepatology"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/1\/50\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:51:55Z","timestamp":1760147515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/1\/50"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,26]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["vaccines11010050"],"URL":"https:\/\/doi.org\/10.3390\/vaccines11010050","relation":{},"ISSN":["2076-393X"],"issn-type":[{"type":"electronic","value":"2076-393X"}],"subject":[],"published":{"date-parts":[[2022,12,26]]}}}