Year 2021 / Volume 113 / Number 2
Original
Liver manifestations in COVID-19 and the influence of pre-existing liver disease in the course of the infection

103-109

DOI: 10.17235/reed.2020.7627/2020

María Fernanda Guerra Veloz, Patricia Cordero Ruiz, María José Ríos-Villegas, Pilar Del Pino Bellido, José Bravo-Ferrer, Rocío Galvés Cordero, María Lorena Cadena Herrera, Carmen Vías Parrado, Francisco Bellido Muñoz, Francisco Vega Rodríguez, Ángel Caunedo Álvarez, Jesús Rodríguez-Baño, Isabel Carmona Soria,

Abstract
Introduction: patients with advanced chronic liver disease (CLD) may be at an increased risk of a severe course due to cirrhosis-associated immune dysfunction. The aim of this study was to determine the prevalence of CLD in COVID-19 patients and to analyze the course of the infection, compared with patients with non-liver disease. Materials and methods: this was a retrospective single center study of all patients with a positive SARS-CoV-2 polymerase chain reaction (PCR) test from March 23rd to April 30th, 2020. Clinical and biochemical data of patients with and without CLD and COVID-19 were collected from the medical records. Result: four hundred and forty-seven patients with a SARS-CoV-2 positive PCR were included, 6.3 % had CLD; 69.7 % of patients with CLD were male, with a median age of 65.5 years and active alcohol consumption and smoking; 75 % had non-advanced liver fibrosis and most had non-alcoholic fatty liver disease (NAFLD). The hospital admission rate (92.9 % vs 47.7 %, p < 0.001), concomitant comorbidities (diabetes 38.5 vs 16.5 %, p = 0.011; obesity 30.8 vs 8.5 %, p = 0.033; cancer 23.1 vs 5 %, p = 0.027; and chronic obstructive pulmonary disease (COPD) 19.2 vs 9 %, p = 0.009) and concomitant antibiotics treatment (19.3 vs 5 %, p = 0.018) were higher in patients with CLD than in those without CLD. In-patient hospital mortality rates were similar in both groups (30.8 vs 19.6 %, p = 0.289). The presence of CLD was not associated with mortality (OR = 1.06; 95 % CI = 0.35-3.18; p = 0.924). However, patients with CLD and COVID-19 who were male, obese or under concomitant antibiotic treatment had the highest risk of mortality according to the univariate analysis. Conclusion: patients with CLD had a higher risk of hospital admission, with worse outcomes during the COVID-19 infection associated to other concomitant comorbidities and a suspicion of bacterial co-infection.
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References
1. Huang C, Wang Y, Li x, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497 -506.
2. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun W, Wang Y. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020 Jun;92(6):577-583. doi: 10.1002/jmv.25757. Epub 2020 Mar 23. PMID: 32162702; PMCID: PMC7228329.
3. Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: Distinctive features and clinical relevance. Journal of Hepatology 2014; 61:1385-1396.
4. Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int [Internet]. 2020; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32251539
5. Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol [Internet]. 2020;1253(day 28):20–1. Available from: http://dx.doi.org/10.1016/S2468-1253(20)30084-4
6. Li J, Fan J-G. Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease. J Clin Transl Hepatol. 2020;8(1):1–5.
7. Wang Y, Liu S, Liu H, Li W, Lin F, Jiang L, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19, Journal of Hepatology (2020).
8. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2009;7:1104-1112.
9. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020. doi: 10.1016/S2468-1253(20)30057-1
10. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;doi:10.1001/jama.2020.1585
11. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775
12. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-1720.
13. Schütte A, Ciesek S, Wedemeyer H, Lange CM. Influenza virus infection as precipitating event of acute-on-chronic liver failure. Journal of Hepatology 2019;70:797-799.
14. Lavarone M, D’Ambrosio R, Soria A, et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19, Journal of Hepatology (2020), doi: https:// doi.org/10.1016/j.jhep.2020.06.001
15. Moon AM, Webb GJ, Aloman C, et al. High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: Preliminary results from an international registry. J Hepatol. 2020;S0168-8278(20)30305-6. doi:10.1016/j.jhep.2020.05.013
16. Y.J. Zhou, K. Zheng, X.B. Wang, H.D. Yan, Q.F. Sun, K.H. Pan, et al.Younger patients with MAFLD are at increased risk of severe COVID-19 illness: a multicenter preliminary analysis J Hepatol (2020), 10.1016/j.jhep.2020.04.027. https://doi.org/10.1016/j.jhep.2020.04.027
17. Ji D, Qin E, Xu J, Zhang D, Cheng G, Wang Y, Lau G. Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. J Hepatol. 2020 Aug;73(2):451-453. doi: 10.1016/j.jhep.2020.03.044. Epub 2020 Apr 8. PMID: 32278005; PMCID: PMC7141624.
18. Chen Y, Varghese Z, Ruan XZ. The molecular pathogenic role of inflammatory stress in dysregulation of lipid homeostasis and hepatic steatosis. Genes Dis. 2014;1(1):106-112. Published 2014 Jul 27. doi: 10.1016/j.gendis.2014.07.007.
19. Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020; 368: m606
20. Piano S, Dalbeni A, Vettore E, et al. Abnormal liver function tests predict transfer to intensive care unit and death in COVID-19 [published online ahead of print, 2020 Jun 11]. Liver Int. 2020;10.1111/liv.14565. doi:10.1111/liv.14565.
21. Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020;S0168-8278(20)30218-X. doi:10.1016/j.jhep.2020.04.006
22. Eslam M, Sanyal AJ, George J; International Consensus Panel. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020 May;158(7):1999-2014.e1. doi: 10.1053/j.gastro.2019.11.312.
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Guerra Veloz M, Cordero Ruiz P, Ríos-Villegas M, Del Pino Bellido P, Bravo-Ferrer J, Galvés Cordero R, et all. Liver manifestations in COVID-19 and the influence of pre-existing liver disease in the course of the infection . 7627/2020


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Publication history

Received: 02/11/2020

Accepted: 11/12/2020

Online First: 04/01/2021

Published: 08/02/2021

Article revision time: 23 days

Article Online First time: 63 days

Article editing time: 98 days


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