Comparison of liver biochemical abnormality between COVID-19 patients with liver cirrhosis versus COVID-19 alone and liver cirrhosis alone

Abstract

Coronavirus disease (COVID-19) patients frequently develop liver biochemical abnormality. However, liver biochemical abnormality in COVID-19 patients with liver cirrhosis is under-recognized. Patients hospitalized during COVID-19 pandemic in China (ie, from February to April 2020) were screened. All of 17 COVID-19 patients with liver cirrhosis consecutively admitted to the Wuhan Huoshenshan Hospital were identified. Meanwhile, 17 age-, sex-, and severity-matched COVID-19 patients without liver cirrhosis admitted to this hospital were selected as a control group; all of 14 cirrhotic patients without COVID-19 consecutively admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command were selected as another control group. Incidence of liver biochemical abnormality and decompensated events were primarily compared. Among the COVID-19 patients with liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 76.50% and 84.60%, respectively; 7 (41.20%) had decompensated events at admission; 1 was transferred to intensive care unit due to gastrointestinal bleeding. Among the COVID-19 patients without liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 58.80% ( P = .271) and 60.00% ( P = .150), respectively. Among the cirrhotic patients without COVID-19, the incidence of liver biochemical abnormality at admission and during hospitalization were 69.20% ( P = .657) and 81.80% ( P = .855), respectively; 11 (78.60%) had decompensated events at admission ( P = .036). None died during hospitalization among the three groups. Liver biochemical abnormality is common in COVID-19 patients with liver cirrhosis. Management of decompensated events in cirrhotic patients without COVID-19 should not be neglected during COVID-19 pandemic.

Evaluation of the effects of the pandemic period on cirrhosis patients

“…Similar to our findings, in their study comparing COVID-19-positive and -negative patients, An et al . reported higher CTP scores in COVID-19-positive cirrhosis patients than in COVID-19-negative cirrhosis patients [ 9 ]. The multicentre study by Qi et al ., in turn, evaluated 21 patients who were previously diagnosed with cirrhosis and positive for COVID-19, and identified 16 patients as CTP-A, 3 patients as CTP-B, and 2 patients as CTP-C after identifying COVID-19 positivity [ 16 ].…”

“…Reporting findings in support of our hypothesis, An et al . suggested that COVID-19-positive cirrhosis patients were better able to access healthcare than COVID-19-negative patients, who did not present to hospital unless they there was a worsening in their condition, resulting in more complications [ 9 ].…”

Rapid Turn From Cirrhosis to Encephalopathy Following COVID-19 Infection: A Cautionary Tale

“…In our case, the lungs were the most susceptible organ to the COVID-19 infection, followed by the liver. It has been demonstrated in several studies that lung injury by the SARS-COV2 is mediated by attaching its spike protein to the ACE2 receptor [1,6,7]. The ACE2 receptor is, incidentally, highly expressed in alveolar type-II cells, as well as liver and bile duct cells, making it possible for the SARS-COV2 to infect cells in these regions most dramatically.…”

“…The coronavirus disease 2019 (COVID-19) infection, caused by severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2) and leading to severe acute respiratory syndrome, has been spreading rapidly worldwide with a deleterious effect on global health. The disease was first discovered on December 19, 2019, in Wuhan, China [1], which was later declared as a public health emergency by the World Health Organization (WHO) on January 30, 2020. This viral pandemic spreads through respiratory droplets via sneezing and coughing and has an incubation period of approximately 3-5 days [2].…”

“…This is particularly true for those with preexisting hepatic cirrhosis, a disease characterized by progressive necrosis, and regeneration of hepatocytes, resulting in the weakening of the immune system and alterations to the gut-liver axis of these patients [5]. Furthermore, the affliction of COVID-19 in patients with liver disease becomes more intense as the virus attaches itself to the angiotensin-converting enzyme 2 (ACE-2) receptors, in both lung and liver bile ducts [1]. This mechanism ultimately triggers liver injury with an end result of increased ammonia levels in the blood and brain resulting in hepatic encephalopathy.…”