Poor outcomes in patients with cirrhosis and Corona Virus Disease-19.
Acute-On-Chronic Liver Failure
/ diagnosis
Betacoronavirus
/ isolation & purification
COVID-19
Cohort Studies
Comorbidity
Coronavirus Infections
/ diagnosis
Disease Progression
Female
Humans
India
/ epidemiology
Length of Stay
/ statistics & numerical data
Liver Cirrhosis
/ diagnosis
Male
Middle Aged
Mortality
Outcome Assessment, Health Care
Pandemics
Pneumonia, Viral
/ diagnosis
Prognosis
Risk Factors
SARS-CoV-2
Acute decompensation
COVID-19
Chronic liver disease
Hepatic failure
Inflammation
Liver
Liver function tests
Pandemic
SARS-CoV-2
Acute-on-chronic liver failure
Journal
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
ISSN: 0975-0711
Titre abrégé: Indian J Gastroenterol
Pays: India
ID NLM: 8409436
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
24
06
2020
accepted:
08
07
2020
pubmed:
18
8
2020
medline:
2
10
2020
entrez:
18
8
2020
Statut:
ppublish
Résumé
There is a paucity of data on the clinical presentations and outcomes of Corona Virus Disease-19 (COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19-positive patients and compare with historical controls. Patients with known chronic liver disease who presented with superimposed COVID-19 (n = 28) between 22 April 2020 and 22 June 2020 were studied. Seventy-eight cirrhotic patients without COVID-19 were included as historical controls for comparison. A total of 28 COVID-19 patients (two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation [AD], and nine with acute-on-chronic liver failure [ACLF]) were included. The etiology of cirrhosis was alcohol (n = 9), non-alcoholic fatty liver disease (n = 2), viral (n = 5), autoimmune hepatitis (n = 4), and cryptogenic cirrhosis (n = 6). The clinical presentations included complications of cirrhosis in 12 (46.2%), respiratory symptoms in 3 (11.5%), and combined complications of cirrhosis and respiratory symptoms in 11 (42.3%) patients. The median hospital stay was 8 (7-12) days. The mortality rate in COVID-19 patients was 42.3% (11/26), as compared with 23.1% (18/78) in the historical controls (p = 0.077). All COVID-19 patients with ACLF (9/9) died compared with 53.3% (16/30) in ACLF of historical controls (p = 0.015). Mortality rate was higher in COVID-19 patients with compensated cirrhosis and AD as compared with historical controls 2/17 (11.8%) vs. 2/48 (4.2%), though not statistically significant (p = 0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully. COVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.
Sections du résumé
BACKGROUND AND AIM
There is a paucity of data on the clinical presentations and outcomes of Corona Virus Disease-19 (COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19-positive patients and compare with historical controls.
METHODS
Patients with known chronic liver disease who presented with superimposed COVID-19 (n = 28) between 22 April 2020 and 22 June 2020 were studied. Seventy-eight cirrhotic patients without COVID-19 were included as historical controls for comparison.
RESULTS
A total of 28 COVID-19 patients (two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation [AD], and nine with acute-on-chronic liver failure [ACLF]) were included. The etiology of cirrhosis was alcohol (n = 9), non-alcoholic fatty liver disease (n = 2), viral (n = 5), autoimmune hepatitis (n = 4), and cryptogenic cirrhosis (n = 6). The clinical presentations included complications of cirrhosis in 12 (46.2%), respiratory symptoms in 3 (11.5%), and combined complications of cirrhosis and respiratory symptoms in 11 (42.3%) patients. The median hospital stay was 8 (7-12) days. The mortality rate in COVID-19 patients was 42.3% (11/26), as compared with 23.1% (18/78) in the historical controls (p = 0.077). All COVID-19 patients with ACLF (9/9) died compared with 53.3% (16/30) in ACLF of historical controls (p = 0.015). Mortality rate was higher in COVID-19 patients with compensated cirrhosis and AD as compared with historical controls 2/17 (11.8%) vs. 2/48 (4.2%), though not statistically significant (p = 0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.
CONCLUSION
COVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.
Identifiants
pubmed: 32803716
doi: 10.1007/s12664-020-01074-3
pii: 10.1007/s12664-020-01074-3
pmc: PMC7428422
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
285-291Références
Dig Dis Sci. 2019 Aug;64(8):2327-2337
pubmed: 30830520
Dig Liver Dis. 2018 Nov;50(11):1225-1231
pubmed: 29910108
J Hepatol. 2020 Sep;73(3):566-574
pubmed: 32298767
Clin Liver Dis (Hoboken). 2020 May 21;15(5):204-209
pubmed: 32489655
Gastroenterology. 2013 Jun;144(7):1426-37, 1437.e1-9
pubmed: 23474284
Hepatol Int. 2017 Mar;11(2):181-187
pubmed: 27624505
J Hepatol. 2020 Nov;73(5):1063-1071
pubmed: 32526252
Lancet Gastroenterol Hepatol. 2020 Jun;5(6):529-530
pubmed: 32203680
J Hepatol. 2018 Aug;69(2):406-460
pubmed: 29653741
J Clin Gastroenterol. 2017 Sep;51(8):734-741
pubmed: 28296656
N Engl J Med. 2020 Jul 9;383(2):120-128
pubmed: 32437596
Hepatology. 2020 Sep;72(3):807-817
pubmed: 32473607
J Pathol. 2004 Jun;203(2):631-7
pubmed: 15141377