Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Among Patients With Preexisting Liver Disease in the United States: A Multicenter Research Network Study

Singh, Shailendra; Khan, Ahmad

doi:10.1053/j.gastro.2020.04.064

Cited by 323 publications

(356 citation statements)

References 8 publications

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“…We found a 31.3% prevalence of liver test abnormalities in patients with SARS-CoV-2 infection, which was slightly lower than reported in previous Western 2,3 and Chinese studies . 4 Pure cholestatic alterations characterised by the increase of both ALP and GGT were extremely rare, whereas GGT elevation was present in 13.6%…”

Section: Discussioncontrasting

confidence: 81%

“…Chinese data on patients with SARS-CoV-2 infection report a prevalence of abnormal liver test as high as 76.3%, while the prevalence in Western patients seems to be lower. [1][2][3][4] However, these studies report baseline or short-term follow-up evaluations. Therefore, the evolution of liver involvement, its correlation with patients' mortality or resolution of SARS-CoV-2 infection is still unknown.…”

mentioning

confidence: 99%

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Liver involvement is not associated with mortality: results from a large cohort of SARS‐CoV‐2‐positive patients

Ponziani

Zompo

Nesci

et al. 2020

Aliment Pharmacol Ther

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Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is frequently associated with liver test abnormalities. Aims To describe the evolution of liver involvement during SARS‐CoV‐2 infection and its effect on clinical course and mortality. Methods Data of 515 SARS‐CoV‐2‐positive patients were collected at baseline and during follow‐up, last evaluation or death. Stratification based on need for hospitalisation, severe disease and admission to intensive care unit (ICU) was performed. The association between liver test abnormalities (baseline and peak values) and ICU admission or death was also explored. Results Liver test abnormalities were found in 161 (31.3%) patients. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) were increased in 20.4%, 19% and 13.6% of patients, respectively. Baseline liver test abnormalities were associated with increased risk of ICU admission (OR 2.19 [95% CI 1.24‐3.89], P = 0.007) but not with mortality (OR 0.84 [95% CI 0.49‐1.41], P = 0.51). Alkaline phosphatase (ALP) peak values were correlated with risk of death (OR 1.007 [95% CI 1.002‐1.01], P = 0.005) along with age, multiple comorbidities, acute respiratory distress syndrome, ICU admission and C‐reactive protein. Alterations of liver tests worsened within 15 days of hospitalisation; however, in patients with the longest median follow‐up, the prevalence of liver test alterations decreased over time, returning to around baseline levels. Conclusions In SARS‐CoV‐2‐positive patients without pre‐existing severe chronic liver disease, baseline liver test abnormalities are associated with the risk of ICU admission and tend to normalise over time. The ALP peak value may be predictive of a worse prognosis.

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Section: Discussioncontrasting

confidence: 81%

mentioning

confidence: 99%

Liver involvement is not associated with mortality: results from a large cohort of SARS‐CoV‐2‐positive patients

Ponziani

Zompo

Nesci

et al. 2020

Aliment Pharmacol Ther

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“…Although they did not calculate differences in the incidence of liver dysfunction between patients with preexisting liver disease and those without, both groups had a high number of patients with LFT abnormalities. 72 Despite the conflicting data, overall the most recent information including a high number of patients indicates that preexisting liver disease confers a higher risk for developing severe COVID-19. Therefore, especial attention should be paid to patients with COVID-19 and preexisting liver diseases, considering the fact that there is evidence of an upregulation of ACE2 (97-fold in a widespread parenchymal pattern) in cirrhotic conditions, and in high-fat diet-induced NASH in animal models, 49 treated with PPARγ agonists such as pioglitazone 49 which could increase susceptibility to SARS-CoV-2 infection.…”

Section: Preexisting Liver Disease and Covid-19mentioning

confidence: 99%

Direct or Collateral Liver Damage in SARS-CoV-2–Infected Patients

et al. 2020

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Liver injury can result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with more than one-third of COVID-19 patients exhibiting elevated liver enzymes. Microvesicular steatosis, inflammation, vascular congestion, and thrombosis in the liver have been described in autopsy samples from COVID-19 patients. Several factors, including direct cytopathic effect of the virus, immune-mediated collateral damage, or an exacerbation of preexisting liver disease may contribute to liver pathology in COVID-19. Due to its immunological functions, the liver is an organ likely to participate in the viral response against SARS-CoV-2 and this may predispose it to injury. A better understanding of the mechanism contributing to liver injury is needed to develop and implement early measures to prevent serious liver damage in patients suffering from COVID-19. This review summarizes current reports of SARS-CoV-2 with an emphasis on how direct infection and subsequent severe inflammatory response may contribute to liver injury in patients with and without preexisting liver disease.

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“…The most common chronic liver disease coexisting with COVID-19 was NASH, seen in 42% of patients with pre-existing liver disease. 42 Cirrhosis was seen in 1.8% cases, and Gastrointestinal and Liver Manifestations of COVID-19 Taneja et al…”

Section: Covid-19 and Chronic Liver Diseasementioning

confidence: 98%

“…The burden of alcohol-related liver disease was estimated to be around 30% in hospitalized patients with COVID-19 in one series. 41 In another series, 42 2,780 COVID-19 patients were analyzed, out of which 9% had pre-existing chronic liver disease. The most common chronic liver disease coexisting with COVID-19 was NASH, seen in 42% of patients with pre-existing liver disease.…”

Section: Covid-19 and Chronic Liver Diseasementioning

confidence: 99%

Gastrointestinal and Liver Manifestations of COVID-19

Taneja

Mehtani

Chawla

2020

Annals of the National Academy of Medical Sciences (India)

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A novel Coronavirus, SARS-CoV-2 illness, has spread throughout the world after the first case was reported from Wuhan, China, in December 2019. This illness typically causes respiratory symptoms like fever, cough, and shortness of breath, although atypical presentation with gastrointestinal symptoms like abdominal pain, nausea, vomiting, or diarrhea are being increasingly reported. The viral RNA has been detected in saliva and stool of such patients, which raises concerns regarding the risk of transmission during gastrointestinal (GI) endoscopy. Many patients also have liver involvement, with the most common manifestation being deranged liver function tests. This review highlights the symptomatology, mechanism, and histopathology findings of SARS-CoV-2 in GI tract and liver. This review also focuses on implications of COVID-19 in patients afflicted with chronic liver disease and in patients undergoing liver transplantation.

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Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Among Patients With Preexisting Liver Disease in the United States: A Multicenter Research Network Study

Cited by 323 publications

References 8 publications

Liver involvement is not associated with mortality: results from a large cohort of SARS‐CoV‐2‐positive patients

Liver involvement is not associated with mortality: results from a large cohort of SARS‐CoV‐2‐positive patients

Direct or Collateral Liver Damage in SARS-CoV-2–Infected Patients

Gastrointestinal and Liver Manifestations of COVID-19

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