Effect of COVID-19 on patients with compensated chronic liver diseases
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ORIGINAL ARTICLE
Effect of COVID‑19 on patients with compensated chronic liver diseases Dong Ji1 · Dawei Zhang1 · Tieniu Yang2 · Jinsong Mu1 · Peng Zhao1 · Jing Xu3 · Chen Li1 · Gregory Cheng4 · Yudong Wang4 · Zhu Chen1 · Enqiang Qin1 · George Lau1,4 Received: 19 May 2020 / Accepted: 20 May 2020 © Asian Pacific Association for the Study of the Liver 2020
Abstract Background and Aim Cytokine storm has been reported in patients with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We examine the incidence of acute on chronic liver failure (ACLF) in COVID-19 patients with pre-existing compensated chronic liver disease (CLD). Methods From 20 Jan 2020 to 7 Feb 2020, we studied 140 consecutive COVID-19 patients admitted to either Fuyang Second People’s Hospital (FYSPH), Anhui or the Fifth Medical Center of Chinese PLA General Hospital (PLAGH) in Beijing, China. Pre-existing CLD includes those with liver cirrhosis assessed by APRI/FIB-4 score and /or ultrasound; NAFLD as identified by either ultrasound or hepatic steatosis index with significant liver fibrosis and chronic hepatitis B (CHB) or hepatitis C (CHC) infection. The diagnosis, grading of severity and clinical management of COVID-19 patients complied to the guideline and clinical protocol issued by the China National Health Commission. All patients had liver function test at least twice weekly till discharge with full recovery or death. Results In total, 3 had liver cirrhosis, 6 patients had CHB, 13 had NAFLD with significant liver fibrosis (one also had CHB). On admission, none had liver decompensation. COVID-19 disease progression was significantly less frequent in non-CLD patients (10/118 8.5%) than CLD patients (13/22 59.1%, p 3.25 or APRI > 1.5 or CHB or subjects with HSI > 36 + BARD score 2–4 [21]. ACLF was defined by APASL criteria: jaundice (serum bilirubin > 85 umol/L) and/or coagulopathy (international normalized ratio > 1.5) complicated within 4 weeks by ascites or encephalopathy [17]. All the data in source documents were confirmed independently by at least two researchers.
Statistical analysis Continuous variables were expressed as mean ± SD and compared using the unpaired, two-tailed student’s t test (for normal distribution data) or median [interquartile range (IQR)] and compared with Mann–Whitney test (for skewed distribution data). Categorical variables were presented as numbers (percentage) and compared by the chi-square test or Fisher’s exact test. A p value 3.25 & APRI > 1.5, 6 had CHB and 13 NAFLD had significant fibrosis (HIS > 36 + BARD scores 2–4; one also had CHB). For the seven patients with CHB, two were already on entecavir 0.5 mg daily before COVID-19 diagnosis (HBV DNA copies 1.7 × 103 and 3.6 × 105 IU/mL) and the other three were started on entecavir 0.5 mg daily after admission (HBV DNA copies all
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