TY - JOUR
T1 - Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)
AU - APASL COVID Task Force, APASL COVID Liver Injury Spectrum Study (APCOLIS Study-NCT 04345640)
AU - Sarin, Shiv Kumar
AU - Choudhury, Ashok
AU - Lau, George K.
AU - Zheng, Ming Hua
AU - Ji, Dong
AU - Abd-Elsalam, Sherief
AU - Hwang, Jaeseok
AU - Qi, Xiaolong
AU - Cua, Ian Homer
AU - Suh, Jeong Ill
AU - Park, Jun Gi
AU - Putcharoen, Opass
AU - Kaewdech, Apichat
AU - Piratvisuth, Teerha
AU - Treeprasertsuk, Sombat
AU - Park, Sooyoung
AU - Wejnaruemarn, Salisa
AU - Payawal, Diana A.
AU - Baatarkhuu, Oidov
AU - Ahn, Sang Hoon
AU - Yeo, Chang Dong
AU - Alonzo, Uzziel Romar
AU - Chinbayar, Tserendorj
AU - Loho, Imelda M.
AU - Yokosuka, Osamu
AU - Jafri, Wasim
AU - Tan, Soeksiam
AU - Soo, Lau Ing
AU - Tanwandee, Tawesak
AU - Gani, Rino
AU - Anand, Lovkesh
AU - Esmail, Eslam Saber
AU - Khalaf, Mai
AU - Alam, Shahinul
AU - Lin, Chun Yu
AU - Chuang, Wan Long
AU - Soin, A. S.
AU - Garg, Hitendra K.
AU - Kalista, Kemal
AU - Batsukh, Badamnachin
AU - Purnomo, Hery Djagat
AU - Dara, Vijay Pal
AU - Rathi, Pravin
AU - Al Mahtab, Mamun
AU - Shukla, Akash
AU - Sharma, Manoj K.
AU - Omata, Masao
N1 - Publisher Copyright:
© 2020, Asian Pacific Association for the Study of the Liver.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background and aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. 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. Results: 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 high mortality [AUROC 0.94, HR = 19.2 (95 CI 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 patients. 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.
AB - Background and aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. 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. Results: 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 high mortality [AUROC 0.94, HR = 19.2 (95 CI 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 patients. 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.
KW - Acute liver injury
KW - COVID-19
KW - Chronic liver disease
KW - SARS CoV2
UR - http://www.scopus.com/inward/record.url?scp=85087508326&partnerID=8YFLogxK
U2 - 10.1007/s12072-020-10072-8
DO - 10.1007/s12072-020-10072-8
M3 - Article
C2 - 32623632
AN - SCOPUS:85087508326
SN - 1936-0533
VL - 14
SP - 690
EP - 700
JO - Hepatology International
JF - Hepatology International
IS - 5
ER -