Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper.

Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic.

Metabolic biomarkers measured from single blood test can identify apparently healthy people at high susceptibility for developing severe pneumonia, and may also be useful for preventive COVID-19 screening.

BACKGROUD: Intensive monitoring of patients with the coronavirus disease should include functional monitoring of the cardiovascular system. Physiologic methods can detect dysfunction of the cardiovascular system, however, it is not always possible to identify initial or hidden dysfunction. Therefore, clinical data should be complemented with results from instrumental methods, particularly electrocardiography. AIM: To identify preclinical electrocardiography signs of cardiovascular system dysfunction in the context of various courses of coronavirus disease in young and middle-aged individuals. MATERIALS AND METHODS: A retrospective analysis of 337 medical records of young and middle-aged individuals (40.0 ± 13.3 years old) was conducted. The analysis of the medical records included electrocardiograms in 12 leads with the assessment of standard parameters, results of laboratory and instrumental tests. In order to identify the main factors predicting an unfavorable course of the coronavirus disease, a factor analysis was conducted using electrocardiography parameters. Logistic regression analysis was used to develop a statistical model for predicting the likelihood of a severe course and fatal outcome of COVID-19, followed by assessing the diagnostic value of the prognostic model using the ROC curve and determining the area under the curve. RESULTS: The main factors predicting an unfavorable course of the new coronavirus disease in young and middle-aged individuals based on electrocardiography data include the α angle factor, the ventricular repolarization factor and the heart rate factor. In addition, as electrocardiography predictors, the elongation of the P wave and PQ interval, the amplitude of the R wave in lead one, the decrease in the T wave amplitude in the precordial leads, and the amplitude of the R wave in leads two and three can be considered. Based on the identified electrocardiography predictors, a mathematical model for predicting a severe course and fatal outcome of the new coronavirus disease was developed. CONCLUSIONS: Thus, electrocardiography is an indicative method that can be influenced by infectious process which is performed for all individuals upon admission to the hospital, allowing this examination to be considered the most accessible for detecting preclinical signs of an unfavorable course of COVID-19.

COVID-19 and Cirrhosis: A Combination We Must Strive to Prevent

The many faces of coronavirus disease 2019: COVID-19 and the liver

Severe acute coronavirus disease 2019 (COVID-19) is uncommon in children; however, its development can lead to longer-term health problems. Understanding factors associated with clinical deterioration in paediatric patients is therefore of public health relevance. Early triage enables closer monitoring, tailored counselling, and timely escalation of care. International studies have associated obesity, chronic illness, and certain sociodemographic factors with worse outcomes. However, robust real-world datasets remain sparse, particularly in Germany, where statutory surveillance often fails to capture detailed clinical data. To address this gap, we analysed 731 polymerase-chain-reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children aged ≤ 15 years reported to the Cologne and Augsburg health departments between January and December 2021. • Primary: Identify independent factors associated with a severe acute COVID-19 course in this population-based study with defined sampling framepaediatric cohort. • Secondary (exploratory): Estimate the prevalence of long COVID–compatible symptoms (persisting >4 weeks) and explore how their frequency changes across acute COVID-19 severity strata. This analysis is based on the CoCo-Fakt cross-sectional study, which captured 731 PCR-confirmed SARS-CoV-2 infections in children aged ≤15 years between January and December 2021. The parent questionnaire captured sociodemographic variables, body mass index (BMI), chronic illnesses, quarantine details, acute COVID-19 severity (asymptomatic to severe), and persisting symptoms (>4 weeks). We then used multivariable logistic regression to examine whether age, sex, socioeconomic status, migration background, BMI, and chronic illness were independently associated with a severe disease course. For exploratory comparisons between children with and without long COVID, we applied t-tests for continuous and Fisher’s exact or chi-square tests for categorical variables. Among the included participants, 67 (9.6%) experienced a severe disease course of COVID-19. In multivariable analysis, chronic illness emerged as the only independent factor associated with severe COVID-19, conferring an almost sixfold higher odds of severe COVID-19 (OR 5.90, 95% CI 2.98–11.68). BMI showed a positive trend but was not statistically significant. Exploratory analyses indicated associations with older age, chronic illness, and increasing acute disease severity. The most frequently reported symptoms were fatigue, sleep disturbances, and problems concentrating. Chronic illness was consistently associated with a higher likelihood of severe acute COVID-19 in children. Given the cross-sectional design, exploratory, parent-reported data suggest older age and more severe acute disease courses may increase the likelihood of persisting symptoms, which warrants confirmation in prospective cohorts. Therefore, children with more severe acute disease or chronic illness may benefit from tailored follow-up to better understand potential long-term impairment, including potential progression to myalgic encephalomyelitis/chronic fatigue syndrome.

ABSTRACTIntroduction:With the current coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised about the risk to children with inflammatory bowel diseases (IBD). We aimed to collate global experience and provide provisional guidance for managing paediatric IBD (PIBD) in the era of COVID-19.Methods:An electronic reporting system of children with IBD infected with SARS-CoV-2 has been circulated among 102 PIBD centres affiliated with the Porto and Interest-group of ESPGHAN. A survey has been completed by major PIBD centres in China and South-Korea to explore management during the pandemic. A third survey collected current practice of PIBD treatment. Finally, guidance points for practice have been formulated and voted upon by 37 PIBD authors and Porto group members.Results:Eight PIBD children had COVID-19 globally, all with mild infection without needing hospitalization despite treatment with immunomodulators and/or biologics. No cases have been reported in China and South Korea but biologic treatment has been delayed in 79 children, of whom 17 (22%) had exacerbation of their IBD. Among the Porto group members, face-to-face appointments were often replaced by remote consultations but almost all did not change current IBD treatment. Ten guidance points for clinicians caring for PIBD patients in epidemic areas have been endorsed with consensus rate of 92% to 100%.Conclusions:Preliminary data for PIBD patients during COVID-19 outbreak are reassuring. Standard IBD treatments including biologics should continue at present through the pandemic, especially in children who generally have more severe IBD course on one hand, and milder SARS-CoV-2 infection on the other.Supplemental digital content:An infographic accompanying this article can be found at.

Severe acute respiratory syndrome coronavirus 2 infection is the cause of coronavirus disease 2019 (COVID-19), which predominantly affects the respiratory system; it also causes systemic and multi-organic disease. Liver damage is among the main extrapulmonary manifestations. COVID-19-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease, and occurs in approximately one in five patients. Abnormal liver test results have been associated with a more severe course of COVID-19 and other complications, including death. Mechanisms linking COVID-19 to liver injury are diverse. Particular consideration should be made for patients with pre-existing liver disease, such as metabolic dysfunction-associated fatty liver disease, chronic liver disease due to viral or autoimmune disease, liver transplant carriers, or cirrhosis, given the risk for more severe outcomes. This manuscript summarizes the current lines of evidence on COVID-19-associated liver injury regarding pathophysiology, clinical significance, and management in both patients with or without pre-existing liver disease, to facilitate clinicians’ access to updated information and patient care. Finally, we mention the ideas and recommendations to be considered for future research.

EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients

Coronavirus disease 2019, immune-mediated inflammatory diseases and immunosuppressive therapies - A Danish population-based cohort study.

Background: Coronavirus disease 2019 (COVID-19) can demonstrate different clinical spectra. Objectives: The current study aimed to analyze the clinical and laboratory risk factors of the severe course of disease in patients with COVID-19. Materials and Methods: Consecutive patients with a diagnosis of COVID-19 pneumonia were included in the present study. The demographic characteristics, comorbid diseases, symptoms, chest computed tomography (CT) findings, laboratory data, oxygen saturation (SpO2), and body temperature of the patients were recorded. The coexistence of pulmonary infiltration in CT and SpO2 of ≤ %93 on fingertip pulse oximeter was defined as the severe course of the disease. Results: A total of 475 patients were included in the current study. The mean age of the patients was 52.02±15.9 years, and 259 (54.5%) participants were male. The disease was mild and severe in 80% (n=380) and 20% (n=95) of the patients. The age of > 50 years, coexistence of hypertension (HT) and diabetes mellitus (DM), neutrophil/lymphocyte ratio (NLR) of > 4, high lactate dehydrogenase (LDH) of > 240 U/L, C-reactive protein (CRP) of > 8 mg/dL, and D-dimer of ≥ 1000 ng/mL were determined to be the risk factors for the severe course of the disease. Conclusion: Age, NLR, CRP, LDH, D-dimer, comorbidity, and coexistence of DM and HT were the independent risk factors for the severe course of the disease. The aforementioned factors should be taken into account during risk stratification and management of patients with COVID-19.

Background: We aimed to perform a systematic search and meta-analysis to evaluate the prognostic value of on-admission liver function tests and pre-existing liver diseases on the clinical course of coronavirus disease 2019 (COVID-19).Methods: The study was registered on PROSPERO (CRD42020182902). We searched five databases between 01/01/2020 and 04/23/2020. Studies that reported on liver-related comorbidities and/or laboratory parameters in patients with COVID-19 were included. The main outcomes were COVID-19 severity, intensive care unit (ICU) admission, and in-hospital mortality. Analysis of predictive models hierarchical summary receiver-operating characteristic (HSROC) was conducted with a 95% confidence interval (CI).Results: Fifty studies were included in the meta-analysis. High specificity was reached by acute liver failure associated by COVID-19 (0.94, 95% CI: 0.71–0.99) and platelet count (0.94, 95% CI: 0.71–0.99) in the case of mortality; chronic liver disease (CLD) (0.98, 95% CI: 0.96–0.99) and platelet count (0.82, 95% CI: 0.72–0.89) in the case of ICU requirement; and CLD (0.97, 95% CI: 0.95–0.98), chronic hepatitis B infection (0.97, 95% CI: 0.95–0.98), platelet count (0.86, 95% CI: 0.77–0.91), and alanine aminotransferase (ALT) (0.80, 95% CI: 0.66–0.89) and aspartate aminotransferase (AST) (0.84, 95% CI: 0.77–0.88) activities considering severe COVID-19. High sensitivity was found in the case of C-reactive protein (CRP) for ICU requirement (0.92, 95% CI: 0.80–0.97) and severe COVID-19 (0.91, 95% CI: 0.82–0.96).Conclusion: On-admission platelet count, ALT and AST activities, CRP concentration, and the presence of acute and CLDs predicted the severe course of COVID-19. To highlight, pre-existing liver diseases or acute liver injury associated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection plays an important role in the prediction of mortality.

Several factors, such as hypertension and diabetes mellitus, are known to influence the course of coronavirus disease 2019 (COVID-19). However, there is currently little information on genetic markers that influence the severity of COVID-19. In this study, we specifically investigated the single nucleotide polymorphism (SNP) rs4986790 in the TLR4 gene to identify a universal marker for preclinical prediction of COVID-19 disease progression. We analyzed the influence of demographics, pre-existing conditions, inflammatory parameters at the time of hospitalization, and TLR4 rs4986790 genotype on the outcome of COVID-19 in a comprehensive cohort (N = 1570). We performed multivariable analysis to investigate the impact of each factor. We confirmed that younger patient age and absence of pre-existing conditions were protective factors against disease progression. Furthermore, when comparing patients with mild SARS-CoV-2 infection with patients who required hospitalization or intensive care or even died due to COVID-19, the AG/GG genotype of TLR4 rs4986790 was found to be a protective factor against COVID-19 disease progression (OR: 0.51, 95% CI: 0.34 - 0.77, p = 0.001). In addition, we demonstrated that low levels of interleukin-6 (IL-6) and procalcitonin (PCT) had a favorable effect on COVID-19 disease severity. In the subsequent multivariable analysis, we confirmed the absence of cardiovascular disease, low levels of IL-6 and PCT, and TLR4 rs4986790 AG/GG genotypes as independent predictors of potential hospitalization and reduction of severe or fatal disease course. In this study, we identified an additional genetic factor that may serve as an invariant predictor of COVID-19 outcome. The TLR4 rs4986790 AG/GG genotype reduced by half the risk of COVID-19 patients requiring hospitalization, intensive care or to have a fatal outcome. In addition, we were able to confirm the influence of previously known factors such as pre-existing conditions and inflammatory markers upon the onset of disease on the course of COVID-19. Based on these observations, we hereby provide another prognostic biomarker that could be used in routine diagnostics as a predictive factor for the severity of COVID-19 prior to SARS-CoV-2 infection.

Testing the Asymptomatic Pre-Surgical Population for Severe Acute Respiratory Syndrome Coronavirus 2

Background & Aims: Recent data show that not only micronutrients but also rare trace elements play an important role in the immune system. We therefore compared admission levels of rare trace elements in patients with a mild and severe course of coronavirus disease 2019 (COVID-19) and described its association with adverse outcomes. Methods: We performed an analysis of the rare trace elements including arsenic, chromium, manganese, molybdenum, nickel and vanadium at admission in consecutively hospitalized patients with COVID-19 from March until April 2020 at the Cantonal Hospital Aarau (Switzerland). We studied associations of the above-mentioned trace elements with severe disease progression, a composite endpoint consisting of in-hospital mortality and/or need for intensive care unit treatment with logistic regression. Results: In total, 67 patients were analyzed with a median age of 67 years of which 63% (n=42) were male. Patients with a severe course of COVID-19 were more males (83% versus 52%, p=0.01) and had more often a chronic obstructive pulmonary disease (13% versus 0%, p=0.01). Median values of analyzed trace elements were similar in both groups with no significant differences. Logistic regression analysis, adjusted for age and gender showed a significant association between manganese levels and the composite endpoint (adjusted OR 0.94, 95% CI 0.89 – 0.99, p=0.03). Conclusions: Little difference in levels of rare trace elements was found in COVID-19 patients with severe disease compared to patients with mild disease. However, lower manganese where associated with higher risk for severe course of COVID-19. Keywords: Trace elements; COVID-19; SARS-CoV-2; Hospital outcomes