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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Poor Outcomes in Patients with Cirrhosis HP and COVID-19

    Authors: Shalimar; Anshuman Elhence; Manas Vaishnav; Ramesh Kumar; Piyush Pathak; Kapil Dev Soni; Richa Aggarwal; Manish Soneja; Pankaj Jorwal; Arvind Kumar; Puneet Khanna; Akhil Kant Singh; Ashutosh Biswas; Neeraj Nischal; Lalit Dhar; Aashish Choudhary; Krithika Rangarajan; Anant Mohan; Pragyan Acharya; Baibaswata Nayak; Deepak Gunjan; Anoop Saraya; Soumya Mahapatra; Govind Makharia; Anjan Trikha; Pramod Garg

    doi:10.21203/rs.3.rs-40220/v1 Date: 2020-07-06 Source: ResearchSquare

    Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease MESHD 2019(COVID-19) in patients with underlying liver disease MESHD. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease MESHD who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis HP, one with compensated cirrhosis HP, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure MESHD(ACLF) were included. The etiology of cirrhosis HP was alcohol(n=9), non-alcoholic fatty liver disease MESHD(n=2), viral(n=5), autoimmune hepatitis MESHD hepatitis HP(n=4), and cryptogenic cirrhosis HP(n=6). The clinical presentations included complications of cirrhosis HP in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis HP and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis HP and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis HP, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

    Pre-existing liver disease MESHD is associated with poor outcome in patients with SARS CoV2 infection MESHD; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

    Authors: Shiv Kumar Sarin; Ashok Choudhury; George K Lau; Ming-Hua Zheng; Dong Ji; Sherief Abd-Elsalam; Jaeseok Hwang; Xiaolong Qi; Ian Homer Cua; Jeong Ill Suh; Jun Gi Park; Opass Putcharoen; Apichat Kaewdech; Teerha Piratvisuth; Sombat Treeprasertsuk; Sooyoung Park; Salisa Wejnaruemarn; Diana A. Payawal; Oidov Baatarkhuu; Sang Hoon Ahn; Chang Dong Yeo; Uzziel Romar Alonzo; Tserendorj Chinbayar; Imelda M. Loho; Osamu Yokosuka; Wasim Jafri; Soeksiam Tan; Lau Ing Soo; Tawesak Tanwandee; Rino Gani; Lovkesh Anand; Eslam Saber Esmail; Mai Khalaf; Shahinul Alam; Chun-Yu Lin; Wan-Long Chuang; A S Soin; Hitendra K Garg; Kemal Kalista; Badamnachin Batsukh; Hery Djagat Purnomo; Vijay Pal Dara; Pravin Rathi; Mamun Al Mahtab; Akash Shukla; Manoj K Sharma; Masao Omata

    doi:10.21203/rs.3.rs-36338/v1 Date: 2020-06-18 Source: ResearchSquare

    Background and Aims: COVID-19 is a dominant pulmonary disease MESHD, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease MESHD (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis HP. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [185 CLD without cirrhosis HP and 43 with cirrhosis HP] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver MESHD disease MESHD (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis HP, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity MESHD obesity HP, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis HP presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure MESHD [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease MESHD; a Child TRANS-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity SERO 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis HP. Conclusions: SARS-Cov-2 infection MESHD causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis HP, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity MESHD obesity HP are more vulnerable and should be closely monitored. 

    Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis HP: A multicenter cohort study

    Authors: Xiaolong Qi; Yanna Liu; Jonathan A. Fallowfield; Jitao Wang; Jianwen Wang; Xinyu Li; Jindong Shi; Hongqiu Pan; Shengqiang Zou; Hongguang Zhang; Zhenhuai Chen; Fujian Li; Yan Luo; Mei Mei; Huiling Liu; Zhengyan Wang; Jinlin Li; Hua Yang; Huihua Xiang; Xiaodan Li; Tao Liu; Ming-Hua Zheng; Chuan Liu; Yifei Huang; Dan Xu; Xiaoguo Li; Ning Kang; Qing He; Ye Gu; Guo Zhang; Chuxiao Shao; Dengxiang Liu; Lin Zhang; Xun Li; Norifumi Kawada; Zicheng Jiang; Fengmei Wang; Bin Xiong; Tetsuo Takehara; Don C. Rockey; COVID-Cirrhosis-CHESS Group

    doi:10.1101/2020.04.24.20072611 Date: 2020-04-28 Source: medRxiv

    Background: Patients with pre-existing cirrhosis HP are considered at increased risk of severe coronavirus disease MESHD 2019 (COVID-19) but the clinical course in these patients has not yet been reported. This study aimed to provide a detailed report of the clinical characteristics and outcomes among COVID-19 patients with pre-existing cirrhosis HP. Methods: In this retrospective, multicenter cohort study, we consecutively included all adult TRANS inpatients with laboratory-confirmed COVID-19 and pre-existing cirrhosis HP that had been discharged or had died by 24 March 2020 from 16 designated hospitals in China. Demographic, clinical, laboratory and radiographic findings on admission, treatment, complications during hospitalization and clinical outcomes were collected and compared between survivors and non-survivors. Findings: Twenty-one patients were included in this study, of whom 16 were cured and 5 died in hospital. Seventeen patients had compensated cirrhosis HP and hepatitis B MESHD hepatitis HP virus infection MESHD was the most common etiology. Lymphocyte and platelet counts were lower, and direct bilirubin levels were higher in patients who died than those who survived (p= 0.040, 0.032, and 0.006, respectively). Acute respiratory distress HP syndrome MESHD and secondary infection MESHD were both the most frequently observed complications. Only one patient developed acute on chronic liver failure MESHD. Of the 5 non-survivors, all patients developed acute respiratory distress HP syndrome MESHD and 2 patients progressed to multiple organ dysfunction syndrome MESHD. Interpretation: Lower lymphocyte and platelet counts, and higher direct bilirubin level might represent poor prognostic indicators in SARS-CoV-2-infected patients with pre-existing cirrhosis HP.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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