I read with interest regarding the use of COVID-19 vaccination in patients with cirrhosis. It is well recognized that patients with cirrhosis, especially decompensated individuals, are prone to acquire bacterial infections as well as viral infections. COVID-19 vaccination is definitely needed for patients with cirrhosis to prevent infection during the pandemic era of COVID-19 worldwide. Dr. John et al. proved that COVID-19 vaccination in patients with cirrhosis was safe and associated with reduced COVID-19 infection as well as the mortality.^{[1, 2]} Though inspiring, some points need further clarification.

Among the studied patients, Child-Pugh class A accounted for about 77%, and class B accounted for about 21%, whereas <2% of patients belonged to Child-Pugh class C. This study enrolled very few patients with decompensated cirrhosis. As shown in the patients’ characteristics, decompensated parameters such as presence of severe ascites, jaundice, or history of variceal bleeding were rarely found. Also, the safety in patients with low platelet counts and/or poor clotting profiles was not revealed. All these patients similarly require the protection of vaccine against infection with COVID-19 urgently. The safety of the COVID-19 vaccine in patients with decompensated cirrhosis may elicit great concern in both patients as well as clinicians. The current study demonstrated only the safety and efficacy of COVID-19 vaccine in patients with compensated cirrhosis. However, further studies on the safety and efficacy of various COVID-19 vaccines in patients with decompensated cirrhosis are still awaited.

我感兴趣地阅读了有关在肝硬化患者中使用 COVID-19 疫苗接种的信息。众所周知，肝硬化患者，尤其是失代偿个体，很容易获得细菌感染和病毒感染。在全球 COVID-19 大流行时期，肝硬化患者肯定需要接种 COVID-19 疫苗以预防感染。约翰博士等人。证明在肝硬化患者中接种 COVID-19 疫苗是安全的，并且与降低 COVID-19 感染和死亡率有关。^{[ 1, 2 ]}虽然鼓舞人心，但有些观点需要进一步澄清。

在所研究的患者中，Child-Pugh A 级约占 77%，B 级约占 21%，而 Child-Pugh C 级的患者<2%。本研究纳入的失代偿期肝硬化患者很少。如患者特征所示，很少发现严重腹水、黄疸或静脉曲张出血史等失代偿参数。此外，没有揭示血小板计数低和/或凝血特征差的患者的安全性。所有这些患者同样迫切需要保护疫苗免受 COVID-19 感染。COVID-19 疫苗在失代偿性肝硬化患者中的安全性可能引起患者和临床医生的极大关注。目前的研究仅证明了 COVID-19 疫苗在代偿期肝硬化患者中的安全性和有效性。然而，关于各种 COVID-19 疫苗在失代偿期肝硬化患者中的安全性和有效性的进一步研究仍在等待。