Low incidence of COVID-19 in a prospective cohort of patients with liver cirrhosis and hepatocellular carcinoma treated at a tertiary medical center during the 2020 pandemic

Patients with liver cirrhosis (LC) are considered to be at increased risk for mortality when acquiring SARS-CoV-2 infection and subsequently developing Corona Virus Disease 2019 (COVID-19). During the COVID-19 pandemic, hospitals are regarded as sites with increased risk of infection. Therefore, pat...

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Published in:	PloS one Vol. 16; no. 12; p. e0258450
Main Authors:	Fründt, Thorben, Kuballa, Lilith, Lütgehetman, Marc, Nörz, Dominik, Arend, Hannes, Brehm, Thomas T, Schulze Zur Wiesch, Julian, Horvatits, Thomas, Horvatits, Karoline, Huber, Samuel, Wege, Henning, Kluwe, Johannes
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 23-12-2021 Public Library of Science (PLoS)
Subjects:	Adult Aged Aged, 80 and over Antibodies Biology and life sciences Carcinoma, Hepatocellular - complications Carcinoma, Hepatocellular - virology Care and treatment Chemiluminescence Chronic infection Cirrhosis Cohort Studies Corona Coronaviruses COVID-19 COVID-19 - epidemiology Diagnosis Female Germany - epidemiology Health care facilities Health risks Hepatocellular carcinoma Hepatoma Humans Immunoassay Immunoglobulin A Immunoglobulin G Immunoglobulin M Incidence Liver Liver cancer Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - virology Liver diseases Liver Neoplasms - complications Liver Neoplasms - virology Male Measurement Medicine and health sciences Medicine, Preventive Methods Middle Aged Mortality Mortality risk Pandemics Patients Preventive health services Prospective Studies Respiratory tract Risk Risk factors SARS-CoV-2 - pathogenicity Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Signs and symptoms Tertiary Tertiary Care Centers - trends Viral antibodies Viral diseases Viruses Germany
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Summary:	Patients with liver cirrhosis (LC) are considered to be at increased risk for mortality when acquiring SARS-CoV-2 infection and subsequently developing Corona Virus Disease 2019 (COVID-19). During the COVID-19 pandemic, hospitals are regarded as sites with increased risk of infection. Therefore, patient contacts are often limited to urgent indications, which could negatively affect disease monitoring. However, data regarding actual infection rates in cirrhotic patients is limited. The aim of this prospective study was to assess the incidence of COVID-19 in patients with LC with/without hepatocellular carcinoma (HCC) with physical presentation at our University Medical Center. Patients were enrolled between 1st April and 30th June 2020 at the University Medical Center Hamburg-Eppendorf, Germany. Symptoms of upper airway infection at baseline and presence of SARS-CoV-2 antibodies (IgG/IgM/IgA) were assessed at baseline and follow-up (FU) using an Electro-chemiluminescence immunoassay (Roche Elecsys). FU visits, including liver function test, clinical assessment and symptom questionnaire, were conducted after 6-8 weeks (FU-1) and 6 months (FU-2). Prior to inclusion of the first patient, obligatory face masks and personal distance were implemented as protective measures. A total of 150 patients were enrolled, 23% (n = 35) also had diagnosis of HCC (median age: 64 years, range: 19-86), 69% were male. Liver function according to Child-Pugh score (CPS) was: CPS A: 46% (n = 62); CPS B: 37% (n = 50); CPS C: 17% (n = 23). Clinical symptoms indicating upper airway infection were present in 53% (n = 77): shortness of breath (n = 40) and coughing (n = 28) were the most frequent. For the 150 patients enrolled, 284 outpatient visits were registered and 33 patients were admitted to the University Medical Center during the follow-up period. After a median of 52 days, n = 110 patients completed FU-1 and n = 72 completed FU-2 after a median of 6.1 months. Only in one patient, an 80-year-old man with stable liver function (CPS A) and advanced HCC, SARS-CoV-2 antibodies were detected at baseline and FU-1, while antibody testing was negative in the remaining patients at baseline, FU-1 and FU-2. The incidence of COVID-19 at our tertiary medical center during the pandemic was low in LC and HCC patients, when simple protective measures were implemented. Therefore, a routine care for patients with chronic liver diseases does not increase the risk of SARS-CoV-2 infection and should be maintained with protective measures.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 HW and JK authors contributed equally and share senior authorship. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0258450