ABSTRACT
Background: liver injury has been reported at variable rate during COVID-19 outbreak, but the impact of pre-existing liver damage and related etiology has not been detailed so far Methods: we studied the reciprocal impact of COVID-19 and viral or metabolic pre-existing advanced liver diseases in patients consecutively admitted at 3 Italian hospitals during the COVID-19 emergency In this preliminary analysis we analyzed the results of patients enrolled in the observational study from February 28th to April 10th 2020;further analyses will be presented at the meeting Simultaneously, we investigated the prevalence of COVID-19 in patients with all HCV genotypes and any stage of fibrosis or HCV genotype 3 and cirrhosis prospectively enrolled in two real world studies on sofosbuvir/velpatasvir pangenotypic treatment recently published by our collaborative group Results: in the observational study, prevalence of HCVAbs and HBsAg positivity, among 332 COVID-19 infected patients matched recently reported national data Demographic and laboratory results in the table Overall 27 4% and 24 3%, respectively showed increased ALT and AST levels Only 10 patients (3 0%) had HCVAbs, 1 with detectable HCV-RNA, the remaining with spontaneously or treatment-induced HCVRNA clearance The frequency of HCVAbs among subjects with increased ALT at baseline (6.6%) was significantly higher than in patients with normal liver enzymes (1 8%) (p=0 038) Pre-existing cirrhosis was reported in 10, 7 had non viral origin cirrhosis, 70% of non viral origin died Overall mortality was 27 1% Cirrhosis, older age, low white blood cell (WBC) and lymphocyte count were independent predictors of death (OR=6 14, 95%CI 1 11-34 15, p=0 038;OR=1 05, 95%CI 1 03-1 07, p=0 0001, OR=1 10, 95% CI 1 01-1 16;OR=1 06, 95%CI 0 39-0 90, p=0 015) Among HCV patients recently treated with pangenotypic regimen, only 1 (0 07%) with cirrhosis in the pangenotypic study and 2 (1%) in the GT3 cirrhosis study reported COVID-19 ascertained infection, all of them recovered Conclusion: in the observational study, prevalence of HCVAbs is low among patients with COVID-19 Pre-existing cirrhosis is associated with high mortality Whether patients recently cured for HCV infection had a smaller exposure or were less vulnerable to COVID-19 as compared to patients with cirrhosis of metabolic origin deserves further investigation.