No abstract

Background: Chronic liver diseases including non-alcoholic fatty liver disease (NAFLD) are associated with COVID-19 progression. With no signs of the pandemic abating, thousands worldwide are at risk of a severe disease course. Objective: We aimed to describe the epidemiological features, clinical course, treatment and outcomes of our patients with COVID-19 and chronic liver disease.Methods: A retrospective descriptive study of COVID-19 patients with chronic liver disease admitted to the National Centre for Infectious Diseases in Singapore between 29th February and 2nd May 2020 was performed. Results: 16 patients had chronic liver disease – 9 had NAFLD. In the NAFLD group, peak ALT was higher (median: 84 U/L vs 38 U/L; P = 0.042) and more patients had hyperlipidaemia (88.9% vs 28.6%; p=0.035), but median Body Mass Index (BMI) was not significantly higher (24.3 kg/m2 vs 24.2 kg/m2). NAFLD patients had a poorer clinical course: more required anti-viral medications (66.7% vs 0%; p=0.011), and time to negative swab was longer (24 days vs 13 days; p=0.008). 3 patients had liver cirrhosis (all non-NAFLD). 1 decompensated but none required intensive care unit admission or died.Conclusion: Our results show that in COVID-19 patients with chronic liver disease, those with NAFLD experience a more severe clinical course. In Asians, NAFLD can have poorer prognostic implications, despite them having only mildly raised BMI. We advocate that patients with NAFLD and liver cirrhosis should be closely monitored for COVID-19 disease progression.