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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)

Authors
 Shiv Kumar Sarin  ;  Ashok Choudhury  ;  George K Lau  ;  Ming-Hua Zheng  ;  Dong Ji  ;  Sherief Abd-Elsalam  ;  Jaeseok Hwang  ;  Xiaolong Qi  ;  Ian Homer Cua  ;  Jeong Ill Suh  ;  Jun Gi Park  ;  Opass Putcharoen  ;  Apichat Kaewdech  ;  Teerha Piratvisuth  ;  Sombat Treeprasertsuk  ;  Sooyoung Park  ;  Salisa Wejnaruemarn  ;  Diana A Payawal  ;  Oidov Baatarkhuu  ;  Sang Hoon Ahn  ;  Chang Dong Yeo  ;  Uzziel Romar Alonzo  ;  Tserendorj Chinbayar  ;  Imelda M Loho  ;  Osamu Yokosuka  ;  Wasim Jafri  ;  Soeksiam Tan  ;  Lau Ing Soo  ;  Tawesak Tanwandee  ;  Rino Gani  ;  Lovkesh Anand  ;  Eslam Saber Esmail  ;  Mai Khalaf  ;  Shahinul Alam  ;  Chun-Yu Lin  ;  Wan-Long Chuang  ;  A S Soin  ;  Hitendra K Garg  ;  Kemal Kalista  ;  Badamnachin Batsukh  ;  Hery Djagat Purnomo  ;  Vijay Pal Dara  ;  Pravin Rathi  ;  Mamun Al Mahtab  ;  Akash Shukla  ;  Manoj K Sharma  ;  Masao Omata  ;  APASL COVID Task Force  ;  APASL COVID Liver Injury Spectrum Study 
Citation
 HEPATOLOGY INTERNATIONAL, Vol.14(5) : 690-700, 2020-09 
Journal Title
 HEPATOLOGY INTERNATIONAL 
ISSN
 1936-0533 
Issue Date
2020-09
MeSH
Acute-On-Chronic Liver Failure* / diagnosis ; Acute-On-Chronic Liver Failure* / virology ; Asia / epidemiology ; Betacoronavirus / isolation & purification ; Coronavirus Infections* / epidemiology ; Coronavirus Infections* / physiopathology ; Coronavirus Infections* / therapy ; Disease Progression ; Female ; Humans ; Liver Cirrhosis* / diagnosis ; Liver Cirrhosis* / epidemiology ; Liver Cirrhosis* / etiology ; Liver Function Tests / methods ; Liver Function Tests / statistics & numerical data ; Male ; Middle Aged ; Pandemics* ; Patient Acuity ; Pneumonia, Viral* / epidemiology ; Pneumonia, Viral* / physiopathology ; Pneumonia, Viral* / therapy ; Prognosis ; Risk Assessment ; Risk Factors
Keywords
Acute liver injury ; COVID-19 ; Chronic liver disease ; SARS CoV2
Abstract
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.
Files in This Item:
T202004697.pdf Download
DOI
10.1007/s12072-020-10072-8
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180405
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