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Abstract Details |
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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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Hepatol Int. 2020 Jul 4;1-11.doi: 10.1007/s12072-020-10072-8. Online ahead of print.
Shiv Kumar Sarin 1, Ashok Choudhury 2, George K Lau 3, Ming-Hua Zheng 3 4, Dong Ji 3 5, Sherief Abd-Elsalam 6, Jaeseok Hwang 7, Xiaolong Qi 8, Ian Homer Cua 9, Jeong Ill Suh 10, Jun Gi Park 10, Opass Putcharoen 11, Apichat Kaewdech 12, Teerha Piratvisuth 12, Sombat Treeprasertsuk 11, Sooyoung Park 13, Salisa Wejnaruemarn 11, Diana A Payawal 14, Oidov Baatarkhuu 15, Sang Hoon Ahn 16, Chang Dong Yeo 16, Uzziel Romar Alonzo 14, Tserendorj Chinbayar 17, Imelda M Loho 18, Osamu Yokosuka 19, Wasim Jafri 20, Soeksiam Tan 21, Lau Ing Soo 21, Tawesak Tanwandee 22, Rino Gani 23, Lovkesh Anand 24, Eslam Saber Esmail 6, Mai Khalaf 6, Shahinul Alam 25, Chun-Yu Lin 26, Wan-Long Chuang 26, A S Soin 27, Hitendra K Garg 28, Kemal Kalista 29, Badamnachin Batsukh 15, Hery Djagat Purnomo 30, Vijay Pal Dara 31, Pravin Rathi 32, Mamun Al Mahtab 25, Akash Shukla 33, Manoj K Sharma 2, Masao Omata 34 35, APASL COVID Task Force, APASL COVID Liver Injury Spectrum Study (APCOLIS Study-NCT 04345640)
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Author information
- 1Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.
- 2Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
- 3Humanity and Health Clinical Trial Center, Hong Kong SAR, China.
- 4Department of Hepatology, NAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- 5Fuyang Second People's Hospital, Fuyang, China.
- 6Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
- 7Keimyung University Dongsan Hospital, Daegu, South Korea.
- 8CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.
- 9Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Global City, Philippines.
- 10Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea.
- 11Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand.
- 12Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand.
- 13Kyungpook National University Hospital, Daegu, South Korea.
- 14Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines.
- 15Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia.
- 16Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
- 17National Center for Communicable Diseases, Ulan Bator, Mongolia.
- 18Department of Gastroenterology and Hepatology "Dharmais", National Cancer Hospital, Jakarta, Indonesia.
- 19Chiba University, Chiba, Japan.
- 20Department of Medicine, WGO Training Center, Aga Khan University, Karachi, Pakistan.
- 21Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia.
- 22Division of Gastroenterology, Department of Medicine, Faculty of Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- 23Division of Hepatobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia.
- 24Hepatologist, Manipal Hospital, New Delhi, India.
- 25Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
- 26Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- 27Liver Transplant Surgery, Medanta, The Medicity, Gurugram, Haryana, India.
- 28Hepatologist and Gastroenterologist, Indraprastha Apollo Hospital, New Delhi, India.
- 29Faculty of Medicine, Cipto Mangunkusumo Hospitall, Universitas, Jakarta, Indonesia.
- 30Kariadi Hospital, Diponegoro University, Semarang, Indonesia.
- 31Yerevan Medical University, Yerevan, Armenia.
- 32Department of Gastroenterology, T.N. Medical College, B.Y.L. Nair. Ch. Hospital, Mumbai, India.
- 33Department of Gastroenterology, Seth GSMC and KEM Hospital, Mumbai, India.
- 34Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.
- 35The University of Tokyo, Tokyo, Japan.
Free PMC article
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.
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