Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study.

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Abstract

Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined.

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Most cited references 33

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Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis

Jing Yang, Ya Zheng, Xi Gou … (2020)

Highlights • COVID -19 cases are now confirmed in multiple countries. • Assessed the prevalence of comorbidities in infected patients. • Comorbidities are risk factors for severe compared with non-severe patients. • Help the health sector guide vulnerable populations and assess the risk of deterioration.

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Epidemic of COVID-19 in China and associated Psychological Problems

Md Ahmed, Oli Ahmed, Zhou AiBao … (2020)

Highlights • There are higher rate of anxiety, depression, alcohol use disorder, and lower mental wellbeing during the COVID-19 epidemic. • Depression and alcohol use disorder were higher among people from Hubei than other provinces. • Non-significant gender differences in anxiety, depression, and mental wellbeing. • Young people, aged 21–40 years old, were psychologically more vulnerable position during the COVID-19 epidemic.

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SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19

Yijin Wang, Shuhong Liu, Hongyang Liu … (2020)

Background Liver enzyme abnormality is common in patients with coronavirus disease 2019 (COVID-19). Whether or not SARS-CoV-2 infection can lead to liver damage per se remains unknown. Here we reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with liver enzyme abnormality. Methods We received 156 patients diagnosed of COVID-19 from two designated centers in China, and compared clinical features between patients with elevated aminotransferase or not. Postmortem liver biopsies were obtained from two cases who had elevated aminotransferase. We investigated the patterns of liver impairment by electron microscopy, immunohistochemistry, TUNEL assay, and pathological studies. Results 64 of 156 (41.0%) COVID-19 patients had elevated aminotransferase. The median levels of ALT were 50 U/L vs. 19 U/L, respectively, AST were 45.5 U/L vs. 24 U/L, respectively in abnormal and normal aminotransferase groups. The liver enzyme abnormality was associated with disease severity, as well as a series of laboratory tests including higher A-aDO2, higher GGT, lower albumin, decreased CD4+ T cells and B lymphocytes. Ultrastructural examination identified typical coronavirus particles characterized by spike structure in cytoplasm of hepatocytes in two COVID-19 cases. SARS-CoV-2 infected hepatocytes displayed conspicuous mitochondrial swelling, endoplasmic reticulum dilatation, and glycogen granule decrease. Histologically, massive hepatic apoptosis and a certain binuclear hepatocytes were observed. Taken together, both ultrastructural and histological evidence indicated a typical lesion of viral infection. Immunohistochemical results showed scanty CD4+ and CD8+ lymphocytes. No obvious eosinophil infiltration, cholestasis, fibrin deposition, granuloma, massive central necrosis, or interface hepatitis were observed. Conclusions SARS-CoV-2 infection in liver is a crucial cause of hepatic impairment in COVID-19 patients. Hence, a surveillance of viral clearance in liver and long outcome of COVID-19 is required.

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Author and article information

Journal

Journal ID (iso-abbrev): J Hepatol

Title: Journal of hepatology

Publisher: Elsevier BV

ISSN (Electronic): 1600-0641

ISSN (Print): 0168-8278

Publication date (Electronic): March 2021

Volume: 74

Issue: 3

Affiliations

[1 ] Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK. Electronic address: Thomas.marjot@ndm.ox.ac.uk.

[2 ] Division of Gastroenterology and Hepatology, University of North Carolina, North Carolina, USA.

[3 ] Centre for Statistics in Medicine, University of Oxford, Oxford, UK.

[4 ] Tropical Medicine and Infectious diseases Department, Tanta University, Tanta, Egypt.

[5 ] Department of Medicine, Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA.

[6 ] Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.

[7 ] Liver Unit, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.

[8 ] Division of Pediatric Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.

[9 ] Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK.

[10 ] Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

[11 ] Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.

[12 ] Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran.

[13 ] Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

[14 ] Barts Liver Centre, Barts Health NHS Trust & Barts & The London School of Medicine & Dentistry, QMUL, London, UK.

[15 ] Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.

[16 ] Sheila Sherlock Liver Unit, Royal Free Hospital, London, UK.

[17 ] Department of Gastroenterology and Hepatology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

[18 ] Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.

[19 ] Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

[20 ] Liver Unit, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.

[21 ] CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.

[22 ] Division of Gastroenterology, University of Washington, Seattle, WA, USA.

[23 ] Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

[24 ] Department of Gastroenterology & Hepatology, Changi General Hospital Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

[25 ] MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease, Zhejiang Province, Wenzhou, Zhejiang, China.

[26 ] Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK; Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.

Article

Publisher Item ID: S0168-8278(20)33667-9

DOI: 10.1016/j.jhep.2020.09.024

PMC ID: 7536538

PubMed ID: 33035628

SO-VID: 8c8965ee-6884-498b-9a72-edd25cf5ba8f

History

Keywords: Acute-on-chronic liver failure,COVID-19,Chronic liver disease,Cirrhosis,SARS-CoV-2

Data availability:

Keywords: Acute-on-chronic liver failure, COVID-19, Chronic liver disease, Cirrhosis, SARS-CoV-2

Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study.

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Abstract

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Novel Coronavirus Disease COVID-19

Most cited references 33

Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis

Epidemic of COVID-19 in China and associated Psychological Problems

SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19

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