Abstract
Patients with cirrhosis are known to have multiple comorbidities and impaired organ system functioning due to alterations caused by chronic liver failure. In the past two years, since the COVID-19 pandemic started, several studies have described the affinity of SARS-CoV-2 with the liver and biliary cells. Considering hepatitis C as a significant independent factor for cirrhosis in Romania, this research was built on the premises that this certain group of patients is susceptible to alterations of their serum parameters that are yet to be described, which might be useful in the management of COVID-19 in these individuals. A retrospective cohort study was developed at a tertiary hospital for infectious disease in Romania, which included a total of 242 patients with hepatitis C cirrhosis across two years, out of which 46 patients were infected with SARS-CoV-2. Stratification by patient weight and COVID-19 status identified several important laboratory serum tests as predictors for acute-on-chronic liver failure and risk for intensive care unit admission. Thus, white blood cell count, lymphocyte count, ferritin, hypoglycemia, prothrombin time, and HCV viral load were independent risk factors for ACLF in patients with COVID-19. High PT, creatinine, BUN, and HCV viral load were the strongest predictors for ICU admission. Inflammatory markers and parameters of gas exchange were also observed as risk factors for ACLF and ICU admission, including procalcitonin, CRP, IL-6, and D-dimers. Our study questions and confirms the health impact of COVID-19 on patients with cirrhosis and whether their laboratory profile significantly changes due to SARS-CoV-2 infection.
Highlights
IntroductionThe clinical manifestations of severe acute respiratory syndrome coronavirus type 2
The clinical manifestations of severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2) range from asymptomatic infection to life-threatening illness [1]
Other studies have shown that patients with cirrhosis who tested positive for SARS-CoV-2 infection died at a rate equivalent to those hospitalized with cirrhosis-related complications who did not test positive for SARS-CoV-2 infection [5]
Summary
The clinical manifestations of severe acute respiratory syndrome coronavirus type 2. (SARS-CoV-2) range from asymptomatic infection to life-threatening illness [1]. It is still uncertain why some patients infected with SARS-CoV-2 evolve to develop severe, lifethreatening forms of coronavirus disease 2019 (COVID-19), whilst others have a mild or even asymptomatic clinical history. Published small-scale studies from tertiary referral centers suggested that patients with cirrhosis who were infected with SARS-CoV-2 died at a rate of up to 40% [4]. Other studies have shown that patients with cirrhosis who tested positive for SARS-CoV-2 infection died at a rate equivalent to those hospitalized with cirrhosis-related complications who did not test positive for SARS-CoV-2 infection [5]
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