Author: Denise Baez
Coronavirus disease 2019 (COVID-19) appears to be associated with liver function deterioration and elevated mortality in patients with cirrhosis, according to a study published in the Journal of Hepatology.
Among 50 patients with cirrhosis with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who were treated at 9 hospitals in the Lombardy region of Italy between March 1 and March 31, 2020, 17 died after a median of 10 days, for a 30-day mortality rate of 34%.
“COVID-19 with respiratory failure was considered the cause of death in 12 (71%) patients, while end-stage-liver disease accounted for death in 5 (29%),” wrote Massimo Iavarone, MD, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Milan, Italy, and colleagues. “Nevertheless, all patients who died from end-stage liver disease required respiratory support for concomitant hypoxemic respiratory failure. Three of the 17 (18%) patients who died were on the liver transplant waiting-list.”
Respiratory support was necessary in 71% of patients, 52% received antivirals, and 80% received heparin. No upper-gastrointestinal bleeding episodes occurred, despite the wide use of anti-thrombosis prophylaxis.
Severity of lung and liver diseases, according to Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF)-C, CLIF-OF, and Model for End-Stage Liver Disease (MELD) scores, independently predicted mortality.
“While the association between severity of lung failure and early mortality was expected, this study is the first to define the predictive role of CLIF and MELD scores in the setting of acute failure of chronic liver disease due to COVID-19,” the authors wrote.
When compared with the last outpatient visit or to blood tests performed at admission, but before SARS-CoV-2 infection, most parameters had changed at the time of COVID-19 diagnosis. Specifically, levels of bilirubin, INR, ALT, and creatinine significantly increased (P =0.026, P = 0.042, and P = 0.024, respectively), whilst albumin levels significantly decreased (P = 0.0003), which led to an increase in the proportion of patients with MELD ≥15 — from 13% to 26% (P = 0.037). In addition, the distribution of Child-Pugh-Turcotte (CPT) scores significantly (P = 0.05) changed and 12 of 26 (46%) patients decompensated. Acute-on chronic liver failure occurred in 14 patients and de novo acute liver injury occurred in 10.
Taking their research a step further, Dr. Iavarone and colleagues compared the patients with cirrhosis and COVID-19 with patients with cirrhosis who were hospitalised a year before for acute liver decompensation due to bacterial infection. They found that the patients hospitalised before the pandemic had an overall mortality rate of 17% compared with the 34% mortality rate of the patients with COVID-19.
“Our study highlighted that infection with SARS-CoV-2 led to rapid clinical deterioration in otherwise stable patients with cirrhosis,” the authors wrote. “As the current pandemic of SARS-CoV-2 is spreading, physicians and hepatologists should be aware of the potential detrimental effects of this infection on the short-term outcome of such a fragile patient population.”