The impact of COVID-19 disease on the natural course of cirrhosis: Before and after starting vaccination

Abstract

BackgroundCirrhosis has been reported as an important risk factor for death in coronavirus disease 2019 (COVID-19) disease. In this study, we aimed to investigate the effects of COVID-19 on the natural course of cirrhosis before and after starting vaccination.MethodsThe cirrhosis patients in our cohort (n: 140; median age:56; 71 female) were included in this study. The median MELD (Model For End-stage Liver Disease) score was 11 (6–25) and CCI (Charlson Comorbidity Index) score was 4 (1–11). In total, 85 had CTP (Child-Turcotte-Pugh)-A, 44 had CTP-B and 11 had CTP-C cirrhosis. The course of COVID-19 in this patient group was evaluated before and after COVID-19 vaccination.ResultsBetween March 2020 and January 2021, 36 of the 140 cirrhosis patients had developed COVID-19. Cirrhosis (+)/COVID-19 (+) and Cirrhosis (+)/COVID-19 (–) groups did not differ in terms of age, CCI and MELD-Na scores, or gender. There were six deaths in the Cirrhosis (+)/COVID-19 (+) group and five in the Cirrhosis (+)/COVID-19 (–) group [6/36 (16.6%) vs. 5/104 (4.8%); p: 0.03]. Patients who died were older, had higher CCI and MELD-Na scores, and lower albumin levels. Having had COVID-19 [6.45 (1.43–29.4); p: 0.015], higher MELD-Na score [1.35 (1.18–1.60); p: 0.001] and higher CCI score [1.65 (1.14–2.39); p: 0.008] were found to be independent predictors of mortality. After effective vaccination started in Turkey, only 11 of the remaining 129 patients developed COVID-19, and only one patient died, who was unvaccinated.DiscussionIn our cirrhotic cohort, COVID-19 disease was associated with 16% mortality in the pre-vaccination period. COVID-19 vaccination prevents serious illness and death due to COVID-19 in cirrhotic patients.

Changes in zonulin levels and possibilities for its correction in patients with liver cirrhosis and hepatic encephalopathy after COVID-19

“…Тяжкий гострий респіраторний синдром, спричинений коронавірусом-2 (SARS-CoV-2), та, як наслідок, коронавірусна хвороба 2019 року (COVID-19) стали причиною смерті багатьох людей у всьому світі за останні роки [1]. Як і для SARS-CoV, ангіотензинперетворюючий фермент 2 (АПФ2), що експресується в понад 80 % альвеолярних клітин легень, є чутливим рецептором і для SARS-CoV-2.…”

“…Відомо, що бактеріальні та різні вірусні інфекції мають гірший перебіг у пацієнтів із цирозом печінки (ЦП) порівняно зі здоровою популяцією. COVID-19 у пацієнтів з хронічним гепатитом та ЦП має більш тяжкий перебіг, що пояснюється імунною дисфункцією, яка притаманна для хворих із ЦП [1]. Ураження печінки при COVID-19 може бути пов'язане з прямою цитопатичною дією вірусу, неконтрольованою імунною реакцією, мікро-та макросудинними тромбозами, сепсисом або медикаментозним ураженням печінки.…”

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…According to already gathered data, it can be assumed that the majority of affected individuals develop a hepatocellular form of injury. It is suggested that a possible background of such a reaction might be related to the similarity between S protein (encoded by the vaccines) and liver-specific proteins [164][165][166][167]. In consequence, autoimmune-like hepatitis might be developed.…”