Elevated Plasma Levels of ICAM1 Predict Mortality in COVID-19 and Sepsis Patients with Liver Cirrhosis

Abstract

Background: An increased covid-19 mortality has been reported in patients with liver cirrhosis. Given a significant association of endothelial damage with both liver disease and covid-19 severity, we investigated key endothelial injury markers in covid-19 patients with and without cirrhosis. Methods: A cross-sectional study with PCR-confirmed moderate/severe covid-19 hospitalized patients with and without cirrhosis was performed. Cirrhosis patients with bacterial sepsis were also recruited. Soluble plasma bio-markers of endothelial cell injury, including intercellular adhesion molecule 1 (ICAM1), von Willebrand Factor (vWF) antigen, vascular endothelial growth factor receptor 1 (vegfr1), angiopoietin 1 and 2 (Ang1, 2) were measured. Findings: A total of 56 hospitalized patients were included belonging to patients in moderate covid-19 category [covid-19 with liver cirrhosis (n=6); covid-19 without liver cirrhosis (n=8)] and severe covid-19 category [covid-19 with liver cirrhosis (n=10); severe covid-19 without liver cirrhosis (n=15)]. 17 patients were with liver cirrhosis plus bacterial sepsis. ICAM1 levels were increased (p=0.04) while vegfr1 (pInterpretation: The study indicates that in patients with liver cirrhosis, altered levels of endothelial injury markers may be associated with a higher covid-19 and sepsis associated in-hospital mortality. Both elevated ICAM1 and MELD would serve as valuable predictors of covid-19 and sepsis associated mortality in cirrhosis patients. Funding: The study was funded by research funds from the Institute of liver and biliary Sciences (ILBS).Declaration of Interests: All authors declare no competing interestsEthics Approval Statement: The institutional review board approved this study (Ethics protocol no IEC/2020/82/NA01).