ABSTRACT
Background: Despite the dominance of respiratory disease, acute-on-chronic liver failure (ACLF) and acute decompensation (AD) have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Moreover, COVID-19 has been associated with increased mortality in patients with end-stage liver disease (ESLD). Aim our study is to evaluate the impact of SARS-CoV-2 infection in patients with ESLD listed for liver transplant (LT). Methods: Data from adults listed for LT with laboratory-confirmed SARS-CoV-2 infection were collected from 7 LT centers across Italy. Results: From March 1st to October 31st 2020, 29 patients listed for LT were tested positive for SARS-CoV-2 infection. Twenty-one patients (72%) were male, median age was 59 years (20-71). The most common indication (70%) for LT was ESLD. The mean MELD score was 18 (8-32). At diagnosis, twenty patients (69%) presented at least one symptom: 38% fever, 28% dry cough, and 31% respiratory distress. Notably, 25% of patients presented hepatic encephalopathy as first presenting symptom. The remaining 9 patients (31%) were completely asymptomatic: nasopharyngeal swab was performed according to surveillance protocols. Twenty-one patients (70%) required hospitalization for the management of COVID-19. Respiratory support was necessary in 13 patients (45%): 5 (17%) required O2-supply, 4 (14%) non-invasive ventilation and 4 (14%) mechanical ventilation. Only five patients (17%) received at least one drug for infection treatment (see table). Heparin was administrated in 7 patients (28%). No bleeding episodes were reported. Eight (%) patients died after a median time of 6 days (2-29) from Covid-19 diagnosis, with a 30-day-mortality rate of 30%. Three patients died of liver failure, while the remaining of multiple organ failures. In the univariate analysis, factors associated with 30-days mortality were respectively presence of comorbidities (0.07), severity of liver disease according to MELD score (0.05) and severity of respiratory failure (0.011). In the cox-regression analysis, only the severity of respiratory failure was significantly associated with the mortality (HR 3.13, IC 1.53-6.3). Conclusions: COVID-19 is associated with elevated mortality in LT candidates, listed for ESLD.
ABSTRACT
Background: In December 2019, a new contagious disease, named COVID-19 and caused by a novel coronavirus (SARSCov- 2), emerged in Wuhan City, China, and is now spreading across international borders Although the disease mainly causes respiratory symptoms, it can also cause impairmentof other organs Interestingly, in many cohorts of patients infected with SARS-Cov-2 it has been noted a more or less significant increase of transaminases, however the real impact of such alteration on liver function is currently unknown This study aimed at evaluating the impact of COVID-19 on the liver function and the clinical outcome of these patients Methods: In this monocentric retrospective study, patients admitted at the ASST-Papa Giovanni XXIII-Bergamo with diagnosis of COVID-19 between 1stMarch and 30thApril 2020 were enrolled A significant increase of hepatic cytolysis was defined as ALT ≥5xULN. Impairment of liver function was defined as association of ALT ≥5xULN with bilirubin ≥1.5 mg/dL and/or INR ≥ 1.7. Results: One thousand two hundred sixty three patients with confirmed SARS-Cov-2 infection were enrolled (mean age 66 years, 76% males). A significant increase of ALT was present in 47 (4%) of patients and among these 8 (17%) and 3 (6%) presented bilirubin ≥1.5 mg/dL and/or INR ≥ 1 7, respectively Eleven/forty seven patients (23%) died after a median of 5 (1-21) days since COVID-19 diagnosis, with 30-day-mortality rate of 19%, nobody for liver-related causes Age and creatinin were the only independent predictors of mortality. Moreover, mortality rate was no significantly increased in patients with ALT ≥5xULNcompared to patients with ALT <5xULN (p=0 94) Conclusion: Infection for SARSCov- 2 may result in increase of transaminases however it is not associated with significant impairment of liver function and increase of mortality.
ABSTRACT
Background: Sars-Cov-2 pneumonia is a pandemic disease with high morbidity and mortality In literature transaminases were frequently found abnormal but their role has not been clarified, particularly in patients with liver disease (LD). Aim of this retrospective study is to explore the role of transaminases on short-term prognosis of hospitalized COVID-19 patients Methods: patients admitted in hospital for respiratory failure due to Sars-Cov-2 were consecutively recruited Primary endpoint: evaluate role of transaminases on disease progression (DP). Secondary endpoints: find possible risk factors for (1) mortality and (2) composite outcome consisting of DP or death Results: 135 patients included Median age was 68 years (IQR 58-74), 33 3% (n=45) were female AST/ ALT at admission and after 7 days were abnormal in about two/thirds of cases CPAP patients had transaminases more frequently abnormal (p=0 01) Transaminases alterations were predictive of DP at univariate analysis In multivariate analysis CRP at day 7 was predictor of DP (OR 3 08 and 1 08) while cardiopathy and ventilation type at admission were significantly associated with death (OR 9.95 and 11.5). Conclusion: This study individuates possible prognostic factors in Sars-Cov-2 pneumonia Transaminases values do not predict DP or death, even if more severe patients have a higher prevalence of transaminases elevation CRP at day 7 is a predictor of DP, while cardiopathy and type of ventilation at admission are predictive factors of short-term mortality.
ABSTRACT
Background: In December 2019, a new contagious disease, named COVID-19 caused by a novel coronavirus (SARSCov- 2) emerged in Wuhan City, China Since February 2020 this disease has also spread to Italy Bergamo, where one of the most active liver transplant (LT) Italian center is located, has been one of the most affected cities by COVID-19 This study aimed to evaluate the impact of COVID-19 in liver transplant patients Methods: From April 1st, 2020, to May 15th, 2020, 660 adult liver transplant recipients were contacted by phone by the medical staff of the Transplant Center at the ASST-Papa Giovanni XXIII-Bergamo The presence of COVID-19 symptoms (fever, cough, dyspnea, asthenia, dysgeusia, anosmia, gastrointestinal complaints and/or myalgia) and contact at risk were investigated Results of RX chest, SARS-Cov-2 nose-swab and hospitalizations, when occurred, were recorded in symptomatic patients Results: Seventy-seven patients (11 7%) reported symptoms related to SARS-Cov-2 infection;patients were primarily males (72 7%), with a median age of 62 9 years (IQR 57 1-69 0) and a median time from LT of 73 6 months (IQR 36 5-135 8) A chest x-rays was performed in 25/77 symptomatic patients (32 5%) and in 17/25 (68 0%) an interstitial pneumonia was found;swabs were performed in 21/77 patients (27 3%) and 17 of them (81 0%) resulted positive Among symptomatic patients, all reported at least two symptoms and in 14 (18 2%) five symptoms were present. Three patients (3.9%) had been hospitalized for transplant-related reasons and 11 patients needed hospitalization because of COVID-19 (14 9%) All hospitalized patients were treated with antibiotics;high dose steroids were added to 8 patients and antiviral therapy (lopinavir/ritonavir) to 4 patients Nine patients (11 7%) needed oxygen therapy One patient died for non-COVID-19 related condition, 2 patients died for COVID-19 (2/76;2 6%) Mortality in hospitalized patients was 21 4% (3/14), COVIDrelated mortality-rate was 15 4% (2/13) and both patients died within one month after LT Conclusion: COVID-19 can affect liver transplant patients, however, in our experience, both the need for hospitalization and deaths do not exceed those observed among the general population.