Effect of COVID-19 on patients with compensated chronic liver diseases

• Published in: Hepatology international 2020-09, Vol.14 (5), p.701-710
• Main Authors: Ji, Dong, Zhang, Dawei, Yang, Tieniu, Mu, Jinsong, Zhao, Peng, Xu, Jing, Li, Chen, Cheng, Gregory, Wang, Yudong, Chen, Zhu, Qin, Enqiang, Lau, George
• Format: Article
• Language: English
• Subjects: Acute-On-Chronic Liver Failure - diagnosis; Acute-On-Chronic Liver Failure - epidemiology; Acute-On-Chronic Liver Failure - etiology; Betacoronavirus - isolation & purification; China - epidemiology; Chronic infection; Cirrhosis; Colorectal Surgery; Coronaviridae; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Cytokine storm; Cytokines; Disease; Disease Progression; Fatty liver; Female; Fibrosis; Health care facilities; Hepatitis; Hepatitis B; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - diagnosis; Hepatitis C; Hepatology; Humans; Incidence; Liver; Liver - diagnostic imaging; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - etiology; Liver diseases; Liver Function Tests - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - diagnosis; Original; Original Article; Pandemics; Patients; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Public health; Respiratory diseases; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Steatosis; Surgery; Ultrasonic imaging; Ultrasonography - methods; Ultrasound; Viral diseases
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-020-10058-6

Background and Aim Cytokine storm has been reported in patients with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We examine the incidence of acute on chronic liver failure (ACLF) in COVID-19 patients with pre-existing compensated chronic liver disease (CLD). Methods From 20 Jan 2020 to 7 Feb 2020, we studied 140 consecutive COVID-19 patients admitted to either Fuyang Second People’s Hospital (FYSPH), Anhui or the Fifth Medical Center of Chinese PLA General Hospital (PLAGH) in Beijing, China. Pre-existing CLD includes those with liver cirrhosis assessed by APRI/FIB-4 score and /or ultrasound; NAFLD as identified by either ultrasound or hepatic steatosis index with significant liver fibrosis and chronic hepatitis B (CHB) or hepatitis C (CHC) infection. The diagnosis, grading of severity and clinical management of COVID-19 patients complied to the guideline and clinical protocol issued by the China National Health Commission. All patients had liver function test at least twice weekly till discharge with full recovery or death. Results In total, 3 had liver cirrhosis, 6 patients had CHB, 13 had NAFLD with significant liver fibrosis (one also had CHB). On admission, none had liver decompensation. COVID-19 disease progression was significantly less frequent in non-CLD patients (10/118 8.5%) than CLD patients (13/22 59.1%, p