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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)

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Author(s)
Shiv Kumar SarinAshok ChoudhuryGeorge K. LauMing-Hua ZhengDong JiSherief Abd-ElsalamJaeseok HwangXiaolong QiIan Homer CuaJeong Ill SuhJun Gi ParkOpass PutcharoenApichat KaewdechTeerha PiratvisuthSombat TreeprasertsukSooyoung ParkSalisa WejnaruemarnDiana A. PayawalOidov BaatarkhuuSang Hoon AhnChang Dong YeoUzziel Romar AlonzoTserendorj ChinbayarImelda M. LohoOsamu YokosukaWasim JafriSoeksiam TanLau Ing SooTawesak TanwandeeRino GaniLovkesh AnandEslam Saber EsmailMai KhalafShahinul AlamChun-Yu LinWan-Long ChuangA. S. SoinHitendra K. GargKemal KalistaBadamnachin BatsukhHery Djagat PurnomoVijay Pal DaraPravin RathiMamun Al MahtabAkash ShuklaManoj K. SharmaMasao Omata
Keimyung Author(s)
Hwang, Jae Seok
Department
Dept. of Internal Medicine (내과학)
Journal Title
Hepatology International
Issued Date
2020
Volume
14
Issue
5
Keyword
COVID-19SARS CoV2Acute liver injuryChronic liver disease
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.
Keimyung Author(s)(Kor)
황재석
Publisher
School of Medicine (의과대학)
Citation
Shiv Kumar Sarin et al. (2020). 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). Hepatology International, 14(5), 690–700. doi: 10.1007/s12072-020-10072-8
Type
Article
ISSN
1936-0541
Source
https://link.springer.com/article/10.1007/s12072-020-10072-8
DOI
10.1007/s12072-020-10072-8
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43091
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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