Impact of chronic liver disease on outcomes of hospitalized patients with COVID‐19: A multicentre United States experience

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in the fall of 2019 and has since become a global pandemic. This virus, which causes coronavirus disease 2019 (COVID-19), has led to over 4.8 million infections and 316,000 deaths worldwide to date. 1 Prior studies have demonstrated advanced age, chronic cardiopulmonary diseases, immunosuppression and obesity as potential risk factors for worse clinical outcomes among patients with COVID-19-with mortality often driven by disease-associated cardiopulmonary failure. 2,3 While the virus primarily affects the lungs, experience from China and the USA also suggests that SARS-CoV-2 may impact extra-pulmonary systems, including the gastrointestinal and hepatobiliary systems. 4,5 Chronic liver disease (CLD), including non-alcoholic fatty liver disease (NAFLD), alcohol-related liver disease and chronic viral hepatitis, comprise a large global burden of disease. 6 Published reports indicate that up to half of adults hospitalized with COVID-19 have abnormal aminotransferase levels and 2%-11% have underlying liver conditions. 7-12 A meta-analysis of 11 observational studies of 2034 adults with COVID-19 from China revealed an overall CLD prevalence of 3%. 13 However, there are limited reports on the nature of liver disease among COVID-19 patients and it remains unclear how underlying CLD influences hepatic injury and clinical outcomes in these patients. Higher rates of liver dysfunction have been observed in patients with more severe cases of COVID-19 and among those requiring admission to the intensive care unit (ICU). 12,14 Given the high prevalence of NAFLD in the USA, as well as metabolic syndrome and

COVID 19 and liver: An A–Z literature review

“…A recent multi-center study by Jagjag et al [77] , found that patients with cirrhosis plus COVID-19 had similar mortality compared to those suffering from cirrhosis alone, but higher than patients with COVID-19 alone. Moreover, a recent work by Hashemi et al proposed the presence of cirrhosis as an independent predictor of mortality [78] . Similarly, 30-days mortality rate was higher in cirrhotics with COVID-19 [79] .…”

Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study

“…High mortality rates from COVID-19 among patients with cirrhosis have been reported in several recently published series. However, these studies were limited to small cohorts of fewer than 50 cirrhosis patients, often lacked a comparison cohort without CLD, or used hospital coding data that is prone to misclassifying liver disease severity[ [6] , [7] , [8] , [9] , [10] , [11] ]. Furthermore, these studies were restricted to single geographical regions limiting generalizability particularly in light of the wide global variability in liver disease aetiology[ 12 ].…”

Letter to the Editor: More Efforts for Detecting the Elevated Liver Biochemistries in Patients With Severe COVID‐19

“…Third, accumulating evidence indicated that chronic liver diseases (CLDs) were independent prognostic factors for patients with COVID-19. (4) Therefore, it would be better to evaluate the influence of different stages of CLDs on liver biochemistries in subgroup analysis, which may contribute to risk stratification and individualized treatments for patients with COVID-19.…”