Abstract
Background and Aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [ 185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted poor outcome [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis. Conclusions: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored. Trial Registration: [NCT04345640] Funding Statement: None. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: Institutional ethics committee approval was obtained.
Highlights
The pandemic of respiratory infection with Severe Acute Respiratory Syndrome Corona Virus -2 (SARS-CoV-2) has already infected 7 million people globally, leaving 4 lacs dead [1]
We present the data obtained from 13 Asian countries and 62 investigators on the spectrum of liver injury and outcomes in chronic liver disease (CLD) patients infected with SARS-Cov-2
CLD without cirrhosis had male preponderance (57.8% versus 41.9%, p = 0.01) with MAFLD being more common (61.1% versus 32.5%, p = 0.003)
Summary
The pandemic of respiratory infection with Severe Acute Respiratory Syndrome Corona Virus -2 (SARS-CoV-2) has already infected 7 million people globally, leaving 4 lacs dead [1]. SARS-Cov-2 is an enveloped, non-segmented, positive-sense RNA virus belonging to β-coronavirus family [2] and causes fever, dry cough and breathing difficulty, which can progress to respiratory distress due to interstitial pneumonia and multi-organ involvement [3, 4]. The latter is due to systemic inflammation leading to a cytokine storm and immune dysfunction often with features of macrophage activation syndrome, as evidenced by hyperferritinaemia, hepatic dysfunction and diffuse intravascular coagulation [5]. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored
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