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)

• Published in: Hepatology international Vol. 14; no. 5; pp. 690 - 700
• Main Authors: Sarin, Shiv Kumar, Choudhury, Ashok, Lau, George K., Zheng, Ming-Hua, Ji, Dong, Abd-Elsalam, Sherief, Hwang, Jaeseok, Qi, Xiaolong, Cua, Ian Homer, Suh, Jeong Ill, Park, Jun Gi, Putcharoen, Opass, Kaewdech, Apichat, Piratvisuth, Teerha, Treeprasertsuk, Sombat, Park, Sooyoung, Wejnaruemarn, Salisa, Payawal, Diana A., Baatarkhuu, Oidov, Ahn, Sang Hoon, Yeo, Chang Dong, Alonzo, Uzziel Romar, Chinbayar, Tserendorj, Loho, Imelda M., Yokosuka, Osamu, Jafri, Wasim, Tan, Soeksiam, Soo, Lau Ing, Tanwandee, Tawesak, Gani, Rino, Anand, Lovkesh, Esmail, Eslam Saber, Khalaf, Mai, Alam, Shahinul, Lin, Chun-Yu, Chuang, Wan-Long, Soin, A. S., Garg, Hitendra K., Kalista, Kemal, Batsukh, Badamnachin, Purnomo, Hery Djagat, Dara, Vijay Pal, Rathi, Pravin, Al Mahtab, Mamun, Shukla, Akash, Sharma, Manoj K., Omata, Masao
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-09-2020; Springer Nature B.V
• Subjects: Acute-On-Chronic Liver Failure - diagnosis; Acute-On-Chronic Liver Failure - virology; Asia - epidemiology; Betacoronavirus - isolation & purification; Bilirubin; Cirrhosis; Colorectal Surgery; Complications; Coronavirus Infections - epidemiology; Coronavirus Infections - physiopathology; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Diabetes; Diabetes mellitus; Disease Progression; Etiology; Fatty liver; Female; Hepatology; Humans; Infections; Injuries; Liver; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - etiology; Liver diseases; Liver Function Tests - methods; Liver Function Tests - statistics & numerical data; Lung diseases; Male; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Mortality; Obesity; Original; Original Article; Pandemics; Patient Acuity; Pneumonia, Viral - epidemiology; Pneumonia, Viral - physiopathology; Pneumonia, Viral - therapy; Prognosis; Risk Assessment; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Surgery; Viral diseases; Asia; COVID-19; SARS CoV2; Acute liver injury; Chronic liver disease
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-020-10072-8

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.