Dataset Information

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).

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.

SUBMITTER: Sarin SK

PROVIDER: S-EPMC7334898 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Publications

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).

Sarin Shiv Kumar SK Choudhury Ashok A Lau George K GK Zheng Ming-Hua MH Ji Dong D Abd-Elsalam Sherief S Hwang Jaeseok J Qi Xiaolong X Cua Ian Homer IH Suh Jeong Ill JI Park Jun Gi JG Putcharoen Opass O Kaewdech Apichat A Piratvisuth Teerha T Treeprasertsuk Sombat S Park Sooyoung S Wejnaruemarn Salisa S Payawal Diana A DA Baatarkhuu Oidov O Ahn Sang Hoon SH Yeo Chang Dong CD Alonzo Uzziel Romar UR Chinbayar Tserendorj T Loho Imelda M IM Yokosuka Osamu O Jafri Wasim W Tan Soeksiam S Soo Lau Ing LI Tanwandee Tawesak T Gani Rino R Anand Lovkesh L Esmail Eslam Saber ES Khalaf Mai M Alam Shahinul S Lin Chun-Yu CY Chuang Wan-Long WL Soin A S AS Garg Hitendra K HK Kalista Kemal K Batsukh Badamnachin B Purnomo Hery Djagat HD Dara Vijay Pal VP Rathi Pravin P Al Mahtab Mamun M Shukla Akash A Sharma Manoj K MK Omata Masao M

Hepatology international 20200704 5

<h4>Background and aims</h4>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.<h4>Methods</h4>Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19.<h4>Results</h4>Altogether, 228 patients [185 CLD witho ...[more]

PMID: 32623632

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Project description:BackgroundDue to pro-inflammatory and hypercoagulation states, COVID-19 infection is believed to increase the risk of stroke and worsen the outcomes of the patients having pre-existing cerebrovascular diseases (CeVD). There is limited literature on prevalence of pre-existing CeVD in COVID-19 patients, and outcomes are unknown. The objective of this meta-analysis is to evaluate the outcomes of COVID-19 patients with pre-existing CeVD.MethodsEnglish full-text-observational studies having data on epidemiological characteristics of COVID-19 patients were identified searching PubMed, Web of Science, and Scopus using MeSH-terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from December 1, 2019 to April 30, 2020. Studies having CeVD or stroke as one of the pre-existing comorbidities and described outcomes including intensive care unit (ICU) admission, mechanical ventilation utilization, and mortality were selected with consensus of three reviewers. Following MOOSE protocol, 11 studies were included. The pooled prevalence of CeVD and outcomes were calculated. Meta-regression was performed, and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CeVD on outcomes of COVID-19 patients. Meta-analysis with random-effects model was used to calculate OR along with its 95% CI from the studies containing data on composite poor outcome.ResultsOut of 8/11 studies showing data on mortality and mechanical ventilation, and 7/11 on ICU admission, pooled prevalence of pre-existing CeVD was 4.4% (244/4987). In age-adjusted meta-regression analysis, pre-existing CeVD was associated with ICU admission [r: 0.60; OR: 1.82 (1.25-2.69)], mechanical ventilation [r: 0.29; OR: 1.33 (1.09-1.63)], and mortality [r: 0.35; OR: 1.42 (1.14-1.77)] amongst COVID-19 hospitalizations. 9/11 studies reported data on binary composite outcomes, the pooled prevalence of pre-existing CeVD was 4.3% (155/3603) and 7.46% (83/1113) amongst COVID-19 hospitalizations and COVID-19 hospitalization-related poor outcomes, respectively. In meta-analysis, COVID-19 patient with pre-existing CeVD had 2.67-fold (1.75-4.06) higher odds of poor outcomes.ConclusionCOVID-19 patients with pre-existing cerebrovascular disease have poor outcomes and extra precautions should be taken in managing such patients during the ongoing pandemic.

Dataset Information

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).

Background and aims

Methods

Results

Conclusions

Publications

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).

Similar Datasets

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