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. 2020 Sep;14(5):701-710.
doi: 10.1007/s12072-020-10058-6. Epub 2020 Jul 30.

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

Dong Ji  1 , Dawei Zhang  1 , Tieniu Yang  2 , Jinsong Mu  1 , Peng Zhao  1 , Jing Xu  3 , Chen Li  1 , Gregory Cheng  4 , Yudong Wang  4 , Zhu Chen  5 , Enqiang Qin  6 , George Lau  7   8
Affiliations

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

Dong Ji et al. Hepatol Int. 2020 Sep.

Abstract

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 < 0.001). One patient with CLD had acute-on-chronic liver failure (ACLF).

Conclusion: Disease progression is significantly higher in those COVID-19 patients with CLD as compared to those with no CLD. ACLF can also occur in patient with pre-existing compensated CLD who had severe COVID-19.

Keywords: Acute-on-chronic liver failure; COVID-19; Chronic liver diseases.

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Conflict of interest statement

Dong Ji, Dawei Zhang, Tieniu Yang, Jinsong Mu, Peng Zhao, Jing Xu, Chen Li, Gregory Cheng, Yudong Wang, Zhu Chen, Enqiang Qin, George Lau declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a. Flow chart for management of COVID-2019 in fever clinics outside Wuhan. b Consort Diagram of study population
Fig. 2
Fig. 2
Profiles of liver enzymes and inflammatory markers in COVID-19 patients (a) with and without chronic liver disease and (b) with or without CHB, at three time points (1: at admission, 2: peak values after admission and 3: at last follow-up)
Fig. 3
Fig. 3
A COVID 19 patients with ACLF (IMV-invasive mechanical ventilation; CRRT-continuous renal replacement therapy; ECMO-extracorporeal membrane oxygenation)
See this image and copyright information in PMC

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