Computer-aided diagnosis (CADx) of polyp histology could support endoscopists in clinical decisionmaking. However, this has not been validated in a real-world setting.

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.

Objective: Abnormal liver tests have been associated with worse clinical outcomes in patients infected with COVID-19. This retrospective observational study from Singapore aims to elucidate simple clinical predictors of abnormal alanine aminotransferase (ALT) in COVID-19 infections. Design: 717 patients hospitalised with COVID-19 at the National Centre for Infectious Diseases (NCID), Singapore, from 23 January–15 April 2020 were screened, of which 163 patients with baseline normal alanine transferase (ALT) and at least two subsequent ALTs performed were included in the final analysis. Information on baseline demographics, clinical characteristics and biochemical laboratory tests were collected. Results: 30.7% of patients developed abnormal ALT. They were more likely to be older (60 vs. 55, p = 0.022) and have comorbidities of hyperlipidaemia and hypertension. The multivariate logistic regression showed that R-factor ≥1 on admission (adjusted odds ratio (aOR) 3.13, 95% Confidence Interval (CI) 1.41–6.95) and hypoxia (aOR 3.54, 95% CI 1.29–9.69) were independent risk factors for developing abnormal ALT. The patients who developed abnormal ALT also ran a more severe course of illness with a greater proportion needing supplementary oxygen (58% vs. 18.6%, p < 0.0005), admission to the Intensive Care Unit (ICU)/High Dependency Unit (HDU) (32% vs. 11.5%, p = 0.003) and intubation (20% vs. 2.7%, p < 0.0005). There was no difference in death rate between the two groups. Conclusions: Liver injury is associated with poor clinical outcomes in patients with COVID-19. R-factor ≥1 on admission and hypoxia are independent simple clinical predictors for developing abnormal ALT in COVID-19.

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