Subject(s)
COVID-19 , Non-alcoholic Fatty Liver Disease , Humans , SARS-CoV-2 , Severity of Illness IndexSubject(s)
Blood Coagulation Disorders/complications , COVID-19/complications , Diabetes Complications , Fatty Liver/complications , Metabolic Diseases/complications , Non-alcoholic Fatty Liver Disease/complications , Obesity/complications , Thrombosis/complications , Humans , Metabolic Syndrome/complications , Risk FactorsABSTRACT
BACKGROUND AND AIM: Cytokine storm has been reported in patients with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We examine the incidence of acute on chronic liver failure (ACLF) in COVID-19 patients with pre-existing compensated chronic liver disease (CLD). METHODS: From 20 Jan 2020 to 7 Feb 2020, we studied 140 consecutive COVID-19 patients admitted to either Fuyang Second People's Hospital (FYSPH), Anhui or the Fifth Medical Center of Chinese PLA General Hospital (PLAGH) in Beijing, China. Pre-existing CLD includes those with liver cirrhosis assessed by APRI/FIB-4 score and /or ultrasound; NAFLD as identified by either ultrasound or hepatic steatosis index with significant liver fibrosis and chronic hepatitis B (CHB) or hepatitis C (CHC) infection. The diagnosis, grading of severity and clinical management of COVID-19 patients complied to the guideline and clinical protocol issued by the China National Health Commission. All patients had liver function test at least twice weekly till discharge with full recovery or death. RESULTS: In total, 3 had liver cirrhosis, 6 patients had CHB, 13 had NAFLD with significant liver fibrosis (one also had CHB). On admission, none had liver decompensation. COVID-19 disease progression was significantly less frequent in non-CLD patients (10/118 8.5%) than CLD patients (13/22 59.1%, p < 0.001). One patient with CLD had acute-on-chronic liver failure (ACLF). CONCLUSION: Disease progression is significantly higher in those COVID-19 patients with CLD as compared to those with no CLD. ACLF can also occur in patient with pre-existing compensated CLD who had severe COVID-19.
Subject(s)
Acute-On-Chronic Liver Failure , Coronavirus Infections , Hepatitis B, Chronic , Liver Cirrhosis , Non-alcoholic Fatty Liver Disease , Pandemics , Pneumonia, Viral , Acute-On-Chronic Liver Failure/diagnosis , Acute-On-Chronic Liver Failure/epidemiology , Acute-On-Chronic Liver Failure/etiology , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Disease Progression , Female , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/diagnosis , Humans , Incidence , Liver/diagnostic imaging , Liver Cirrhosis/diagnosis , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Liver Function Tests/methods , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2 , Ultrasonography/methodsSubject(s)
Betacoronavirus/genetics , Coronavirus Infections/complications , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/virology , Pneumonia, Viral/complications , Adult , Age Factors , Aged , Body Mass Index , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/virology , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/immunology , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Retrospective Studies , Risk Factors , SARS-CoV-2Subject(s)
Betacoronavirus , Coronavirus Infections , Liver Diseases , Pandemics , Pneumonia, Viral , COVID-19 , Humans , SARS-CoV-2ABSTRACT
BACKGROUND: We aimed to clarify high-risk factors for coronavirus disease 2019 (COVID-19) with multivariate analysis and establish a predictive model of disease progression to help clinicians better choose a therapeutic strategy. METHODS: All consecutive patients with COVID-19 admitted to Fuyang Second People's Hospital or the Fifth Medical Center of Chinese PLA General Hospital between 20 January and 22 February 2020 were enrolled and their clinical data were retrospectively collected. Multivariate Cox regression was used to identify risk factors associated with progression, which were then were incorporated into a nomogram to establish a novel prediction scoring model. ROC was used to assess the performance of the model. RESULTS: Overall, 208 patients were divided into a stable group (n = 168, 80.8%) and a progressive group (n = 40,19.2%) based on whether their conditions worsened during hospitalization. Univariate and multivariate analyses showed that comorbidity, older age, lower lymphocyte count, and higher lactate dehydrogenase at presentation were independent high-risk factors for COVID-19 progression. Incorporating these 4 factors, the nomogram achieved good concordance indexes of .86 (95% confidence interval [CI], .81-.91) and well-fitted calibration curves. A novel scoring model, named as CALL, was established; its area under the ROC was .91 (95% CI, .86-.94). Using a cutoff of 6 points, the positive and negative predictive values were 50.7% (38.9-62.4%) and 98.5% (94.7-99.8%), respectively. CONCLUSIONS: Using the CALL score model, clinicians can improve the therapeutic effect and reduce the mortality of COVID-19 with more accurate and efficient use of medical resources.
Subject(s)
Betacoronavirus , Clinical Decision Rules , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Severity of Illness Index , Adult , Aged , COVID-19 , China/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/mortality , Disease Progression , Female , Humans , Lymphocyte Count , Male , Middle Aged , Multivariate Analysis , Nomograms , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2ABSTRACT
Annually, around 850 liver transplantation is performed in Beijing, China. Recently, the new coronavirus pneumonia (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) has affected nearly 200 countries worldwide. 2019-nCov can cause severe lung disease, multiple-organ damage, and significant mortalities. Liver transplant recipients, because of long-term oral immunosuppressant effects, may be more susceptible to 2019-nCoV infection and have a worse prognosis than the general population. It is urgent to set up guidelines for the prevention, diagnosis, and treatment of COVID-19 in liver transplant recipients. In this article, we reviewed the clinical aspects of 2019-nCoV infection, characteristics of liver transplant recipients, immunosuppressant usage, and potential drug interactions to provide recommendations to clinical staff managing liver transplant recipients during the COVID-19 epidemic.