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High rates of 30-day mortality in patients with cirrhosis and COVID-19.
Iavarone, Massimo; D'Ambrosio, Roberta; Soria, Alessandro; Triolo, Michela; Pugliese, Nicola; Del Poggio, Paolo; Perricone, Giovanni; Massironi, Sara; Spinetti, Angiola; Buscarini, Elisabetta; Viganò, Mauro; Carriero, Canio; Fagiuoli, Stefano; Aghemo, Alessio; Belli, Luca S; Lucà, Martina; Pedaci, Marianna; Rimondi, Alessandro; Rumi, Maria Grazia; Invernizzi, Pietro; Bonfanti, Paolo; Lampertico, Pietro.
  • Iavarone M; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy. Electronic address: massimo.iavarone@gmail.com.
  • D'Ambrosio R; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
  • Soria A; Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy.
  • Triolo M; Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Pugliese N; Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.
  • Del Poggio P; UO Gastroenterologia. Policlinico S. Marco, Zingonia-Bergamo, Italy.
  • Perricone G; Hepatology and Gastroenterology Unit, Niguarda Hospital, Milan, Italy.
  • Massironi S; Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy.
  • Spinetti A; Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy.
  • Buscarini E; UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy.
  • Viganò M; Division of Hepatology, Ospedale San Giuseppe, Italy.
  • Carriero C; Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy.
  • Fagiuoli S; Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Aghemo A; Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.
  • Belli LS; Hepatology and Gastroenterology Unit, Niguarda Hospital, Milan, Italy.
  • Lucà M; Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Pedaci M; UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy; University of Milan, Milan, Italy.
  • Rimondi A; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; University of Milan, Milan, Italy.
  • Rumi MG; Division of Hepatology, Ospedale San Giuseppe, Italy; University of Milan, Milan, Italy.
  • Invernizzi P; Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy.
  • Bonfanti P; Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy.
  • Lampertico P; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
J Hepatol ; 73(5): 1063-1071, 2020 11.
Article in English | MEDLINE | ID: covidwho-591707
ABSTRACT
BACKGROUND &

AIMS:

Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis.

METHODS:

In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records.

RESULTS:

Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections.

CONCLUSION:

COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. LAY

SUMMARY:

Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.
Subject(s)
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Pandemics / Liver Cirrhosis / Liver Function Tests Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Country/Region as subject: Europa Language: English Journal: J Hepatol Journal subject: Gastroenterology Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Pandemics / Liver Cirrhosis / Liver Function Tests Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Country/Region as subject: Europa Language: English Journal: J Hepatol Journal subject: Gastroenterology Year: 2020 Document Type: Article