S2456 Clinical Outcomes of Acute-on-Chronic Liver Failure in Patients With SARS-CoV-2 Infection

Abstract

INTRODUCTION: Acute decompensation in the setting of chronic cirrhosis is most commonly attributed to infections such as SBP, UTI, and Pneumonia. While these associations are well-documented within the literature, a paucity of cases exist which analyze the effects of the novel coronavirus (Sars-CoV-2) on chronic liver disease. We present the clinical course and outcomes of 3 patients who developed acute decompensated cirrhosis secondary to Covid19. CASE DESCRIPTION/METHODS: Patient 1: 34 year old M with a PMH of decompensated cirrhosis secondary to alcoholic cirrhosis presented due to anasarca, shortness of breath, and fevers. Hospitalized 2 weeks prior due to decompensation of cirrhosis with ascitic fluid studies negative for SBP. The 2nd hospitalization he developed acute hypoxemic respiratory failure, liver dysfunction, and shock. Sars-Cov-2 PCR was positive. He passed away 5 days later. Patient 2: 62 year old male with a PMH of decompensated cirrhosis secondary to NASH who presented to the hospital with ascites. After lactulose treatment and paracentesis he was discharged after 2 days. Readmitted 10 days later for encephalopathy with an ammonia of 122 µ/dL, asterixis, and ascites. The patient was Sars-Cov-2 PCR positive. He was discharged after 5 days of supportive care, lactulose, and resolution of encephalopathy. 7 days later he was readmitted due to hepatic encephalopathy diagnosed with SBP secondary to Klebsiella bacteremia. Patient 3: 57 year old male with a PMH of decompensated cirrhosis secondary to chronic Hepatitis C infection and alcohol abuse who presented with fever and dyspnea. Discharged after 2 weeks of inpatient care for COVID-19 and presented again 2 weeks later with encephalopathy and abdominal pain. Diagnostic paracentesis was negative for SBP and the patient was discharged after receiving supportive care, lactulose, and resolution of encephalopathy. DISCUSSION: In all three patients acutely decompensated liver cirrhosis was intrinsically involved in their course. Patient 1 had decompensated liver cirrhosis just two weeks prior to his Covid19 diagnosis, and patients 2 and 3 had comorbid decompensated liver cirrhosis one week and two weeks, respectively, after their discharge from a previous Covid19-associated admission. This suggests that Covid19 is a risk factor for decompensation in patients with chronic liver disease and may be a marker for poor prognosis. Larger studies are needed to quantify its effect on morbidity and mortality in this unique patient population.Table 1.: Demographics and CharacteristicsTable 2.: Outcomes in Cirrhosis Patients.