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)

Sarin, Shiv Kumar; Choudhury, Ashok; Lau, George; Zheng, Ming‐Hua; Ji, Dong; Abd-Elsalam, Sherief; Hwang, Jang‐Sun; Qi, Xiaolong; Homer, Ian; Suh, Jeong Ill; Park, Jun-Gi; Putcharoen, Opass; Kaewdech, Apichat; Piratvisuth, Teerha; Treeprasertsuk, Sombat; Park, Soo‐Young; Wejnaruemarn, Salisa; Payawal, Diana A.; Baatarkhuu, Oidov; Ahn, Sang Hoon; Yeo, Chang Dong; Alonzo, Uzziel Romar; Chinbayar, Tserendorj; Loho, Imelda Maria; Yokosuka, Osamu; Jafri, Wasim; Tan, Soek‐Siam; Soo, Lau Ing; Tanwandee, Tawesak; Gani, Rino Alvani; Anand, Lovkesh; Esmail, Eslam Saber; Khalaf, Mai; Alam, Shahinul; Lin, Chun‐Yu; Chuang, Wan‐Long; Soin, Arvinder S.; Garg, Hitendra; Kalista, Kemal Fariz; Batsukh, Badamnachin; Purnomo, Hery; Dara, Vijay Pal; Rathi, Pravin; Mahtab, Mamun Al; Shukla, Akash; Sharma, Manoj Kumar; Omata, Masao

doi:10.1007/s12072-020-10072-8

Cited by 219 publications

(249 citation statements)

References 28 publications

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“…This finding is consistent with other literature on high frequency of transaminitis in COVID-19-which is also associated with poorer outcomes severity-but low rates of jaundice [17,18]. International studies have found that among patients with underlying chronic liver disease with or without cirrhosis, acute liver injury on presentation was > 30% [4,19]. As our population had a low prevalence of cirrhosis (2%), we lacked power to identify such a trend.…”

Section: Discussionsupporting

confidence: 89%

“…Notably, all these studies were in cohorts from China, with far lower rates of underlying obesity, diabetes, and other comorbidities than in our cohort. In addition to HS, chronic liver disease generally has also been associated with increased disease severity in COVID-19 [4,19]. We were unable to evaluate the effect of non-HS chronic liver disease on disease severity as prevalence was low in this cohort.…”

Section: Discussionmentioning

confidence: 88%

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Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

et al. 2020

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Background Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. Aims To characterize the impact of HS on disease severity and liver injury in COVID-19. Methods We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. Results In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. Conclusions HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 88%

Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

et al. 2020

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“…The ongoing outbreak of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) A cumulative total of nearly 25 million cases and 800 000 deaths have been reported since the start of the outbreak 1 The majority of cases often present with mild symptoms, like fever, cough and shortness of breath; however, the severity of symptoms increases with presence of co-morbidities and pre-existing diseases, such as the presence of chronic liver disease. 2 The data on immunosuppression therapy, post-transplant status and impact of SARS-CoV-2 infection on a liver graft as well as the overall survival in liver graft recipients is largely inadequate. A similar lack of information is present regarding the treatment, drug interaction and overall outcome with solid organ transplant and corona virus disease 2019 (COVID- 19).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in Liver Transplant Recipients - A Series with Successful Recovery

Choudhury¹,

Reddy²,

Venishetty³

et al. 2020

Journal of Clinical and Translational Hepatology

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The severe acute respiratory syndrome corona virus-2 (referred to as SARS CoV2) pandemic had a great impact on public life in general as well as on populations with preexisting disease and co-morbidities. Liver transplant and immunosuppressant medication predisposes to more severe disease and is often associated with poor outcome. The clinical features, disease course, treatment and process of modulating the immunosuppression is challenging. Here, we describe the clinical presentation, treatment and outcomes in six liver transplant recipients. Out of those six patients, three had mild, one had moderate and one had severe COVID-19, and one was asymptomatic. The immunosuppression minimization or withdrawal was done based upon the clinical severity. Consideration of tocilizumab and/o convalescent plasma as well as antivirals i.e. remdesvir done in severe cases. The routine practice of prophylactic anticoagulation, consideration of repurposed drugs (i.e. teicoplanin and doxycycline), and watchful monitoring of asymptomatic recipients helped to achieve an uneventful recovery.

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“…She had a successful outcome after treatment and was discharged home after 7 days of hospitalization. In a small study from Asia, APASL ACLF Research Consortium (AARC) reported ACLF (using APASL criteria) in five of 43 (11.6%) patients with known cirrhosis (25 with compensated and 18 with decompensated cirrhosis) [52]. In this study, two of 25 (8%) with compensated cirrhosis and six of 18 (33.3%) with decompensated cirrhosis died compared to only 2.1% of patients CLD without cirrhosis.…”

Section: Liver Failurementioning

confidence: 62%

What GI Physicians Need to Know During COVID-19 Pandemic

2020

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The worldwide pandemic of COVID-19, caused by the virus SARS-CoV-2, continues to cause significant morbidity and mortality in both low-and high-income countries. Although COVID-19 is predominantly a respiratory illness, other systems including gastrointestinal (GI) system and liver may be involved because of the ubiquitous nature of ACE-2 receptors in various cell lines that SARS-CoV-2 utilizes to enter host cells. It appears that GI symptoms and liver enzyme abnormalities are common in COVID-19. The involvement of the GI tract and liver correlates with the severity of disease. A minority (10-20%) of patients with COVID-19 may also present initially with only GI complaints. The most common GI symptoms are anorexia, loss of smell, nausea, vomiting, and diarrhea. Viral RNA can be detected in stool in up to 50% of patients, sometimes even after pharyngeal clearance, but it is unclear whether fecal-oral transmission occurs. Liver enzymes are elevated, usually mild (2-3 times), in a substantial proportion of patients. There are many confounding factors that could cause liver enzyme abnormalities including medications, sepsis, and hypoxia. Although infection rates in those with preexisting liver disease are similar to that of general population, once infected, patients with liver disease are more likely to have a more severe disease and a higher mortality. There is a paucity of objective data on the optimal preventive or management strategies, but few recommendations for GI physicians based on circumstantial evidence are discussed.

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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)

Cited by 219 publications

References 28 publications

Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

COVID-19 in Liver Transplant Recipients - A Series with Successful Recovery

What GI Physicians Need to Know During COVID-19 Pandemic

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