Impact Of Chronic Liver Disease Research Articles

Severity and Mortality in Covid-19 With Hepatitis B Co-Infection A Systematic Review and Meta-Analysis

This systematic review and meta-analysis investigate the severity and mortality in COVID-19 patients coinfected with Hepatitis B Virus (HBV). Utilizing established databases and adhering to PRISMA guidelines, 15 studies were included after a rigorous selection and data extraction process, with quality assessed using the Newcastle–Ottawa Scale (NOS). Statistical analysis was conducted using Review Manager (RevMan) software. The findings indicate a significantly higher risk of severe clinical outcomes and mortality in COVID-19 patients with HBV co-infection compared to those without HBV. Among patients with both HBV and COVID-19, 30.2% developed severe clinical outcomes, compared to 19.5% in COVID-19 patients without HBV. Mortality rates were also higher in the co-infected group (4.9%) compared to those with only COVID-19 (3.4%). The study notes considerable heterogeneity among the included studies, as indicated by high I2 values. These results align with previous findings on the impact of chronic liver diseases on COVID-19 outcomes but contrast with some studies suggesting a potential protective effect of HBV. The analysis also considers the complexities of managing COVID-19 in HBV patients, particularly the risks associated with corticosteroid therapy and HBV reactivation, while acknowledging limitations such as variability in methodologies and potential publication biases. The study underscores the heightened severity and mortality risks for COVID-19 patients with HBV co-infection, emphasizing the need for tailored management strategies and further research into the mechanisms and optimal treatment protocols for this patient population.

Management of Stroke in Patients With Chronic Liver Disease: A Practical Review.

Chronic liver disease (CLD) is a highly prevalent condition. There is burgeoning recognition that there are many people with subclinical liver disease that may nonetheless be clinically significant. CLD has a variety of systemic aberrations relevant to stroke, including thrombocytopenia, coagulopathy, elevated liver enzymes, and altered drug metabolism. There is a growing body of literature on the intersection of CLD and stroke. Despite this, there have been few efforts to synthesize these data, and stroke guidelines provide scant guidance on this topic. To fill this gap, this multidisciplinary review provides a contemporary overview of CLD for the vascular neurologist while appraising data regarding the impact of CLD on stroke risk, mechanisms, and outcomes. Finally, the review addresses acute and chronic treatment considerations for patients with stroke-ischemic and hemorrhagic-and CLD.

Impact of chronic liver disease on SARS-CoV-2 infection outcomes: Roles of stage, etiology and vaccination

Since the first identification in December of 2019 and the fast spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, it has represented a dramatic global public health concern. Though affecting mainly the respiratory system, SARS-CoV-2 disease, defined as coronavirus disease 2019 (COVID-19), may have a systemic involvement leading to multiple organ dysfunction. Experimental evidence about the SARS-CoV-2 tropism for the liver and the increasing of hepatic cytolysis enzymes during infection support the presence of a pathophysiological relationship between liver and SARS-CoV-2. On the other side, patients with chronic liver disease have been demonstrated to have a poor prognosis with COVID-19. In particular, patients with liver cirrhosis appear extremely vulnerable to infection. Moreover, the etiology of liver disease and the vaccination status could affect the COVID-19 outcomes. This review analyzes the impact of the disease stage and the related causes on morbidity and mortality, clinical outcomes during SARS-CoV-2 infection, as well as the efficacy of vaccination in patients with chronic liver disease.

Specific aspects of social significant liver diseases, risk factors, and food safety: A comprehensive review

In the contemporary landscape of scientific inquiry, the study and assessment of risk factors for chronic liver diseases have expanded substantially. This surge in research is driven by the heightened prevalence of common risk factors and the consequential socio-economic impact of chronic liver diseases. Beyond their medical implications, these diseases pose significant economic challenges. Recent scientific investigations affirm that chronic hepatitis (CH) and liver cirrhosis (LC) are predominantly shaped by identifiable risk factors. In this article, synthesizes current research, providing compelling evidence that underscores the societal importance of chronic liver diseases and their association with risk factors. The prevalence of these diseases and their directly linked risk factors is notably high in diverse populations. Moreover, the economic implications of chronic liver diseases extend beyond healthcare, highlighting the need for a multidimensional approach in understanding and addressing these health challenges. As the scientific community unravels the multifaceted nature of chronic liver diseases, this review contributes to the growing body of evidence supporting the assertion that a comprehensive understanding of risk factors is crucial. Furthermore, the abstract advocates for an integrated approach, exploring the intersectionality between risk factors for liver diseases and the critical issue of food safety. By recognizing and addressing this complex interplay, policymakers, healthcare professionals, and researchers can develop targeted interventions that encompass both medical and socio-economic dimensions, fostering a more resilient and healthier society.

Impact of Chronic Liver Diseases on Specific Health-Related Quality of Life among a Sample in Babylon Governorate

Patients with chronic liver disease experience a variety of symptoms with profound negative impact on health-related quality of life. Also, non-life-threatening symptoms such as fatigue, muscle and joint pain, pruritus, loss of appetite, and digestive problems can hugely decrease their quality of life and well-being. Objective: This study aims to identify most properties of the specific health related quality of life in patients suffering from (CLDs), and in order to find out the relationships among an overall evaluation of specific health related quality of life in patients with (CLDs) with some associated variables. They include but not limited to [sociodemographic characteristics]. A cross sectional study design was performed at the Gastrointestinal and Liver Diseases center in Babylon governorate, including 133 participants collected from 2nd January 2022 to 4th April 2022. There is a clear discrepancy in the level of responses for the studied domains, Specific quality of life for patients studied assigned that observed responses are mostly moderate, and they are accounted 15 (55.17%), and items of having a high-level evaluation accounted 11 (37.93%), and leftover items by having a low evaluation are accounted 2 (6.90%). According to this research findings, patients with (CLDs) have to go down regarding specific quality of life, since most studied items are accounted a moderate responding. The necessity to carry out similar further large-scale studies in different Iraqi regions in order to identify aspects of excellence and regression that progress and slow in the light of which the results of evaluating the health status related to the specific quality of life for (CLDs) patients.

New suggested weighed score for evaluating impact of chronic liver diseases on health-related quality of life patients among a sample in Babylon Governorate in Iraq

Objectives: This study aimed monitoring and creating a new suggested weighted score for evaluating specific health related quality of life for patients with chronic liver diseases through extracted significant factors, in order to developing of the studied score that was prepared by Yonossi in 1999 to assess the quality of life of patients with liver diseases. Methodology: A cross sectional study design was conducted to evaluate specific health related quality of life in patients with chronic liver diseases. A convenient sample targeted 133 patients with chronic liver diseases who had been diagnosed and treated by Hepatologist in the "Martyr Dr. Majid Hassan Al-Jubouri center for Gastrointestinal and Liver Diseases in Babylon Governorate". This study applied a suitable questionnaire. This instrument contents several domains, such that: "Abdominal Symptoms, Fatigue, Systemic Symptoms, Emotional Function, Activity and Worry ". Results: Studied patients have a differentiated assessments concerning specific health related quality of life on the level of studied domains, which showed a discrepancy in the levels of assess, requiring re-organization of its components to show the most important patterns from which these domains can be formed in the interpretation of the respondents’ attitudes towards the quality of their healthy life.

Impact of chronic liver disease on COVID-9 infection at Zagazig University Hospitals

Impact of chronic liver disease on COVID-9 infection at Zagazig University Hospitals

Predictors of clinical outcomes of hospitalized patients with Covid-19: focusing on pre-existing liver disease.

Chronic liver disease is associated with immune system dysfunction, which can lead to a greater risk of infections. Our goal was to assess the impact of chronic liver disease in Covid-19 outcome in hospitalized patients and to identify predictors of the infection’s severity. A retrospective case–control study of adult patients hospitalized in Hospital da Senhora da Oliveira–Guimarães, between March 15th 2020 and March 15th 2021, was performed. Demographic factors, clinical and biochemical data were analyzed, as well as the need for oxygen therapy, non-invasive or mechanical ventilation, admission in the intensive care unit and mortality. A total of 336 patients were included, 168 with and 168 without chronic liver disease, with similar comorbidities and pulmonary involvement. Patients with chronic liver disease had a lower percentage of need for oxygen therapy. Regardless of the presence of chronic liver disease, older age, a previously diagnosed pulmonary disease or cardiac condition and more than 25% pulmonary involvement were associated with increased mortality. The need for non-invasive ventilation was higher if the patient was obese, had a previously diagnosed pulmonary disease or had a higher percentage of lung parenchyma involvement. The need for admission in the intensive care unit was associated with obesity and a greater than 25% pulmonary involvement. Chronic liver disease had no impact on Covid-19 severity. Regardless of the presence of chronic liver disease, obesity had an important role in all outcomes except mortality. A higher percentage of lung parenchyma involvement was associated with worst outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11739-022-03044-3.

Financial burden in adults with chronic liver disease: A scoping review.

The economic burden of chronic liver disease is rising; however, the financial impact of chronic liver disease on patients and families has been underexplored. We performed a scoping review to identify studies examining financial burden (patient/family health care expenditures), financial distress (material, behavioral, and psychological consequences of financial burden), and financial toxicity (adverse health outcomes of financial distress) experienced by patients with chronic liver disease and their families. We searched MEDLINE, Embase, Cochrane Library, and the Web of Science online databases for articles published since the introduction of the Model for End-Stage Liver Disease score for liver transplantation allocation in February 2002 until July 2021. Final searches were conducted between June and July 2021. Studies were included if they examined the prevalence or impact of financial burden or distress among patients with chronic liver disease and/or their caregivers. A total of 19 observational studies met inclusion criteria involving 24,549 patients and 276 caregivers across 5 countries. High rates of financial burden and distress were reported within the study populations, particularly among patients with hepatic encephalopathy, hepatocellular carcinoma, and liver transplantation recipients. Financial burden and distress were associated with increased pre- and posttransplantation health care utilization and poor health-related quality of life as well as caregiver burden, depression, and anxiety. None of the included studies evaluated interventions to alleviate financial burden and distress. Observational evidence supports the finding that financial burden and distress are underrecognized but highly prevalent among patients with chronic liver disease and their caregivers and are associated with poor health outcomes. There is a critical need for interventions to mitigate financial burden and distress and reduce financial toxicity in chronic liver disease care.

Chronic liver disease and cirrhosis increase morbidity in geriatric patients treated surgically for hip fractures: analysis of the US Nationwide Inpatient Sample

BackgroundThis study aimed to evaluate the impact of chronic liver disease and cirrhosis on inpatient outcomes of geriatric hip fracture surgery.Materials and methodsUsing population-based retrospective study design, this study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005–2014, identifying patients aged ≥ 65 years undergoing hip fracture repair. Main outcomes were in-hospital mortality, any/specific complications, non-routine discharge, extended length of stay (LOS) and hospital costs. Associations between cirrhosis, non-cirrhotic chronic liver disease and outcomes were determined using regression analysis.ResultsData of 347,363 hip fracture patients included 344,035 without liver disease, 1257 with non-cirrhotic chronic liver disease and 2,071 with cirrhosis. After adjustments, non-cirrhotic chronic liver disease was significantly associated with non-routine discharge (OR: 1.247, 95% CI: 1.038–1.498), acute kidney injury (OR: 1.266, 95% CI: 1.039–1.541), extended LOS (OR: 1.285, 95% CI: 1.122–1.473) and hospital costs (beta: 9173.42, 95% CI: 6925.9–11,420.95) compared to no liver disease; while cirrhosis was significantly associated with higher risk of in-hospital mortality (OR: 2.325, 95% CI: 1.849–2.922), any complication (OR: 1.295, 95% CI: 1.143–1.467), acute kidney injury (OR: 1.242, 95% CI: 1.177–1.433), non-routine discharge (OR: 1.650, 95% CI: 1.412–1.928), extended LOS (OR: 1.405, 95% CI: 1.263–1.562) and hospital costs (beta: 6680.24, 95% CI: 4921.53–8438.95) compared to no liver disease.ConclusionIn geriatric hip fracture patients undergoing surgical repair, non-cirrhotic chronic liver disease and cirrhosis independently predict non-routine discharge, acute kidney injury, prolonged LOS and greater hospital costs, and cirrhosis is also significantly associated with greater risk of any complication and in-hospital mortality.

The current pediatric perspective on type B and C hepatic encephalopathy

That children present with hepatic encephalopathy (HE) in the setting of acute liver failure (ALF) is accepted and a recognized prognostic factor for survival [1,2]. What is less understood is the impact of chronic liver disease (CLD) on the neuro-cognitive and –psychiatric development and outcomes of children with chronic liver disease early in life. Much is extrapolated from the adult literature or from work in experimental models. But what distinguishes children is that central nervous system development, characterized by massive brain growth, is ongoing at the time of liver disease, arguably exposing them to unique risks, something which cannot be extrapolated from adults. The purpose of this brief review is to summarize what is distinctive about the neurocognition of children with CLD or having presented CLD or portosystemic bypass in childhood.

Impact of Chronic Liver Disease on COVID-19 Mortality: The Erciyes University COVID-19 Center Experience

Impact of Chronic Liver Disease on COVID-19 Mortality: The Erciyes University COVID-19 Center Experience

Comparison of the impact of chronic corticosteroid therapy on critical care outcomes of COVID-19 patients with and without history of chronic liver disease

There is a paucity of studies investigating the impact of chronic corticosteroid use for coexisting conditions in patients with Coronavirus Disease 2019 (COVID-19). Additionally, the information regarding the impact of chronic liver disease (CLD) on COVID-19 outcomes is evolving. Our study aims to investigate hospitalization outcomes of patients with COVID-19 on long term corticosteroids for coexisting conditions while also seeking to compare outcomes between such patients with a history of CLD to analyze the impact on mortality. We conducted a retrospective chart review across our 10-hospital network identifying patients on chronic corticosteroids (Prednisone ≥ 5 mg daily dose or equivalent dose of another steroid, for a duration of 30 days or more) who were hospitalized with COVID-19 from March 1, 2020 to June 30, 2020. Of these patients who met inclusion criteria, patients were then divided into groups based upon their history of CLD. Primary outcomes of the study looked to investigate the hospitalization outcomes of patients with a history of CLD and comorbid conditions requiring chronic corticosteroid use. Secondary outcomes sought to further investigate risk factors for mortality in our study sample. 837 charts were reviewed. 139 patients met inclusion criteria of which 34 patients had a history of CLD. Statistical analysis demonstrated no difference in length of hospital stay but increased ICU admission rate in the CLD group (41.2% vs 23.8%). No statistically significant difference was seen in between the CLD and non-CLD groups in term of complication rates and 28-day mortality. However, chronic corticosteroids patients were found to have higher rates of ICU admission and overall 28-day and ICU mortality in comparison to patients who were not on chronic corticosteroids prior to COVID-19 hospitalization. The larger contributor to COVID-19 severity was likely chronic corticosteroid use rather than CLD and thus chronic corticosteroid use should be limited throughout the COVID-19 pandemic especially in patients with additional speculated risk factors for COVID-19 such as CLD.

The clinical impact of chronic liver disease in patients undergoing transcatheter and surgical aortic valve replacement: Systematic analysis of the 2011-2017 US hospital database.

In this study, we use a national database to evaluate post-transcatheter (TAVR)/surgical aortic valve replacement (SAVR) outcomes stratified using chronic liver disease (CLD). In patients undergoing TAVR and SAVR, the surgical risks should be optimized; this includes evaluating hepatic diseases that may pose an operative risk. 2011-2017 National Inpatient Sample was used to select in-hospital TAVR and SAVR cases, which were stratified according to CLD (cirrhosis, hepatitis B/C, alcoholic/fatty/nonspecific liver disease). The cases-controls were matched using propensity score matching and compared with various endpoints. After matching for demographics and comorbidities, for TAVR, 606 and 1818 were with or without CLD; for SAVR, 1353 and 4059 were with and without CLD. In TAVR, there was no differences in mortality (2.81% vs. 2.75% OR 1.02 95% CI 0.58-1.78) or length of stay (6.29 vs. 6.44d p=0.29), and CLD-present patients had marginally increased costs ($228,415 vs. $226,682 p=0.048). There were no differences in complications. In multivariate, there was no difference in mortality (aOR 1.02 95% CI 0.58-1.79). In SAVR, CLD patients had higher mortality (7.98% vs. 3.23% OR 2.60 95% CI 2.00-3.38), length of stay (13.3 vs. 11.3 days p < 0.001), and costs ($273,487 vs. $238,097 p < 0.001). CLD patients also had increased respiratory failure (9.02% vs. 7.19% OR 1.28 95% CI 1.03-1.59) and bleeding (8.43% vs. 6.33% OR 1.36 95% CI 1.08-1.71). In multivariate, CLD had higher mortality (aOR 2.60 95% CI 2.00-3.38). CLD is associated with higher mortality and complications in patients undergoing SAVR; however, no correlation was found in patients undergoing TAVR.

Prognosis of French COVID-19 patients with chronic liver disease: A national retrospective cohort study for 2020

Background & AimsThe impact of chronic liver disease on outcomes in patients with COVID-19 is uncertain. Hence, we aimed to explore this association.MethodsWe explored the outcomes of all adult inpatients with COVID-19 in France, in 2020. We computed adjusted odds ratios to measure the associations between chronic liver disease, alcohol use disorders, mechanical ventilation and day-30 in-hospital mortality.ResultsThe sample comprised 259,110 patients (median [IQR] age 70 (54–83) years; 52% men), including 15,476 (6.0%) and 10,006 (3.9%) patients with chronic liver disease and alcohol use disorders, respectively. Death occurred in 38,203 (15%) patients, including 7,475 (28%) after mechanical ventilation, and 2,941 (19%) with chronic liver disease. The adjusted odds ratios for mechanical ventilation and day-30 mortality were 1.54 (95% CI 1.44–1.64, p <0.001) and 1.79 (1.71–1.87, p <0.001) for chronic liver disease; 0.55 (0.47–0.64, p <0.001) and 0.54 (0.48–0.61, p <0.001) for mild liver disease; 0.64 (0.53–0.76; p <0.001) and 0.71 (0.63–0.80, p <0.001) for compensated cirrhosis; 0.65 (0.52–0.81, p <0.001) and 2.21 (1.94–2.51, p <0.001) for decompensated cirrhosis; 0.34 (0.24–0.50; p <0.001) and 1.38 (1.17–1.62, p <0.001) for primary liver cancer; and 0.82 (0.76–0.89; p <0.001) and 1.11 (1.05–1.17; p <0.001) for alcohol use disorders. Chronic viral hepatitis; non-viral, non-alcoholic chronic hepatitis; organ, including liver, transplantation, and acquired immunodeficiency syndrome were not associated with COVID-19-related death.ConclusionChronic liver disease increased the risk of COVID-19-related death in France in 2020. Therapeutic effort limitation may have contributed to COVID-19-related death in French residents with a liver-related complication or an alcohol use disorder.Lay summaryWe studied the outcomes, including mechanical ventilation and day-30 mortality, of all adults with COVID-19 who were discharged from acute and post-acute care in France in 2020 (N = 259,110). Patients with mild liver disease; compensated cirrhosis; organ, including liver, transplantation; or acquired immunodepression syndrome were not at increased risk of COVID-19-related mortality. Patients with alcohol use disorders, decompensated cirrhosis, or primary liver cancer were at increased risk of COVID-19-related mortality but were less likely to receive mechanical ventilation. Our results suggest that therapeutic effort limitation may have contributed to the excess mortality in French residents with a liver-related complication or an alcohol use disorder.

Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study.

BackgroundItaly has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory.ObjectivesAim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy).MethodsCOVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission.ResultsAmong 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42–4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39–14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21–5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings.ConclusionMortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage.

Health related quality of life in chronic liver diseases.

The impact of chronic liver diseases (CLDs) on health-related quality of life (HRQoL) is relevant to understand the burden of these conditions and inform decision-making processes related to their care. Studies simultaneously comparing the HRQoL of patients affected by the major CLDs to that of the general population are still lacking and are the subject of this study. Using the EQ-5D-3L questionnaire, we analysed and compared HRQoL data from 2962 Italian patients affected by CLDs and forming a representative sample of the general Italian population (6800 individuals). Exploratory analyses were conducted to investigate the effects of each CLD on HRQoL, using the general population as reference and adjusting for possible confounders. Patients with CLDs (HBV, HCV, PSC, PBC, AIH, NAFLD/NASH) in the chronic hepatitis stage and with compensated cirrhosis (CC) showed HRQoL similar to the general population. However, AIH were more likely to report problems in self-care and lower EQ-5D VAS score, while NAFLD/NASH and HCV showed an increased risk of anxiety/depression. On the other hand, with progression to more advanced stages of liver disease (DC or HCC), HRQoL decreased significantly with higher risk of reporting problems in the physical domains, and significant reductions in the VAS and utility index scores. Different subtypes of CLD affected different QoL domains. This study therefore provides a real estimate of the impact of CLDs on patients' HRQoL, and represents a much needed tool to inform decision-making while assessing the effectiveness and cost-effectiveness of the care of these patients.

S1047 Impact of Chronic Liver Disease and Cirrhosis on COVID-19 Patient Outcomes

INTRODUCTION: There is increasing evidence suggesting that liver dysfunction is a risk factor for severe COVID-19 illness. However, due to the low prevalence of liver disease and cirrhosis in the general population, larger studies looking at the impact of these conditions have utilized data from international registries which do not necessarily reflect the US population. Our study aims to assess the association between chronic liver disease and COVID-19 clinical outcomes across a single large inpatient cohort. METHODS: We performed a retrospective single-center study at a large tertiary care hospital. All index admissions of adult patients with confirmed COVID-19 between 3/1 and 4/20/2020 were included. A manual chart review was performed to collect data on baseline patient characteristics, medical comorbidities, and clinical outcomes. Patients with chronic liver disease (CLD) and cirrhosis were compared to the control group, who had no known underlying liver disease. SAS 9.4 was used for analysis. RESULTS: A total of 1935 patients met our inclusion criteria of which 1869 (96.6%) had no underlying liver disease, 66 (3.4%) had CLD, and 21 (1.1%) had cirrhosis. Table 1 shows baseline patient characteristics. There were a higher proportion of males in the CLD and cirrhosis cohorts compared to the control group (67% and 76% vs 50%; P = 0.0105). Patients with cirrhosis and chronic liver disease also had a significantly lower average BMI compared to the control group (25.8 and 27.3 vs. 31.8; P = 0.002). There was no difference in comorbidities between all three cohorts. Figure 1 shows the distribution of liver disease etiology for patients with chronic liver disease and cirrhosis. In terms of outcomes, patients with cirrhosis had a significantly higher mortality (RR 2.1 [95% CI 1.33–3.62; P = 0.0022]) compared to non-cirrhotics (Table 2). There was also a trend towards increased 30-day readmission in the cirrhotic cohort (RR 2.35 [95% CI 0.86–6.42]; P = 0.0950) however no difference in rate of ICU admission or intubation. Patients with CLD did not have an increase in mortality, ICU admission, intubation, or 30-day re-admission compared to the control group. CONCLUSION: Our study demonstrates that cirrhosis is associated with increased mortality in COVID-19 while chronic liver disease in the absence of cirrhosis does not confer the same degree of clinical risk. Future studies performed on a larger scale should evaluate how decompensated disease and MELD score may impact this risk profile.Table 1.: Baseline patient characteristicsTable 2.: Morbidity and mortality associated with cirrhosis and chronic liver diseaseFigure 1.: Etiology of liver disease in patients with CLD and cirrhosis.

S1162 Impact of Chronic Liver Disease on Outcomes of Hospitalized Patients With COVID-19: A Multicenter United States Experience

INTRODUCTION: Liver injury has been described with COVID-19, and early reports suggested 2–11% of patients had chronic liver disease (CLD). However, there are limited reports on the nature of liver disease among COVID-19 patients and how underlying CLD influences clinical outcomes. Given the high prevalence of NAFLD in the US, as well as metabolic syndrome and obesity being potential poor prognostic factors for COVID-19, we hypothesized that CLD, particularly NAFLD, may be associated with more severe clinical course and worse outcomes among patients with COVID-19. We aimed to study the effect of existing liver-related comorbidities on the manifestations and outcomes of hospitalized adults with COVID-19. METHODS: This was a multicenter retrospective study of hospitalized adults with laboratory-confirmed COVID-19. The primary outcome was the impact of CLD on disease severity, including hospital length of stay, ICU admission, need for mechanical ventilation, and death. Secondary outcomes included the comparisons of patient characteristics, other clinical manifestations of disease, and laboratory results on admission between patients with and without CLD. Further analyses were performed by stratifying patients with CLD into those with and without cirrhosis, and into NAFLD and non-NAFLD. Student’s t-test/Fisher Exact test were performed for univariate analyses; logistic regression were performed for multivariable analyses. RESULTS: Of 363 patients included, 69 (19%) had CLD, including 55 (15.2%) with NAFLD. Patients with CLD had longer length of stay (Table 1). After controlling for age, gender, obesity, cardiac diseases, hypertension, hyperlipidemia, diabetes, and pulmonary disorders, CLD and NAFLD were independently associated with ICU admission [(aOR 1.77, 95% CI 1.03–3.04) and (aOR 2.30, 95% CI 1.27–4.17)] and mechanical ventilation [(aOR 2.08, 95% CI 1.20–3.60) and (aOR 2.15, 95% CI 1.18–3.91)] (Table 2). Presence of cirrhosis was an independent predictor of mortality (aOR 12.5, 95% CI 2.16–72.5). CONCLUSION: Overall, nearly one-fifth of hospitalized COVID-19 patients had CLD, which was associated with more critical illness. This association was observed in patients with NAFLD but not in those with non-NAFLD CLD. This difference might, in part, be secondary to the association between NAFLD and obesity, inflammation and oxidative stress. While patients with NAFLD were more likely to be admitted to the ICU and require mechanical ventilation, only those with cirrhosis had an increased risk of mortality.Table 1.: Baseline characteristics and admission laboratory data of patients hospitalized with COVID-19Table 2.: Multivariable analyses for (A) the need for mechanical ventilation, (B) ICU admission, and (C) death

PREEXISTING CHRONIC LIVER DISEASE AS AN INDEPENDENT RISK FACTOR REINTUBATION IN MECHANICALLY VENTILATED PATIENTS

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hepatic functional status is not routinely considered a risk factor for ventilation liberation failure. We wanted to evaluate the impact of chronic liver disease (CLD) on the risk of reintubation after mechanical ventilation for ≥ 24 hours. METHODS: We queried the Medical Information Mart for Intensive Care database (MIMIC-III) for adult patients admitted to intensive care and mechanically ventilated for ≥ 24 hours. Data for 8,521 patient was analyzed, 623 had existing CLD and 7898 had no underlying liver abnormality. Only the first intubation for the hospital stay was included, and patient who underwent tracheotomy or terminal extubation were excluded. We identified underlying liver disease using International Classification of Diseases, 9th revision and clinical modification (ICD-9-CM) codes, we compared the means using unpaired t-test, and carried out logistic regression analysis after adjustment for Charlson Comorbidity Index. RESULTS: The mean age of patents receiving mechanical ventilation (MV) without underlying chronic liver disease was 72.1 years 95% CI [71, 73.2], the mean age of patients with CLD receiving MV was 57.1 years, 95% CI [55.5, 58.7], p < 0.001. 54.5% patient were men in the non-CLD sample and 66.1% were men in the CLD sample. The mean duration of ventilation was 7.12 days, 95% CI [6.94, 7.3] in the non-CLD sample vs 6.83 days, 95% CI [6.29, 7.37] in the CLD sample, p = 0.40. The mean length of ICU stay for non-CLD patient was 10.42 days, 95% CI [10.2, 10.6] in comparison for CLD patients was 10.2 days, 95% CI [9.52, 10.9] p = 0.59. 25.1% died during their hospital stay in the non-CLD cohort vs. 37.8% in the CLD cohort, adjusted OR 1.82, 95 % CI [1.53, 2.15]. Of the 7898 non-CLD patients undergoing mechanical ventilation 1488 were reintubated within 72 hours (18.8%), of the 623 CLD patients undergoing mechanical ventilation 144 (23.1%) were reintubated within 72 hours, adjusted OR 1.3 95 % CI [1.06, 1.57], p = 0.009. CONCLUSIONS: Patient having underlying chronic liver disease undergoing mechanical ventilation were younger in age, and had a higher in hospital mortality compared to general population receiving mechanical ventilation without underlying liver disease. Patient with chronic liver disease were 1.3 times more likely to get reintubated within 72 hours of extubation compared to patients without underlying liver abnormality. The mean duration of ventilation and mean ICU length of stay was not significantly different in the two samples. CLINICAL IMPLICATIONS: Underlying chronic liver disease should be accounted as an independent risk factor for reintuabtion in mechanically ventilated patients. DISCLOSURES: No relevant relationships by Muhammad Sameed, source=Web Response No relevant relationships by Muhammad Waleed, source=Web Response No relevant relationships by Jennie Zhang, source=Web Response