Impact of SARS CoV-2 /COVID-19 infection on the course of advanced chronic liver disease and hepatocellular carcinoma

Abstract

Background About 20% of patients infected with SARS-CoV-2 develop COVID-19—the disease that has dominated health care in the last two years. The course of COVID-19 in patients with advanced liver disease tends to be severe, patients also suffer from a higher risk of complications and death. The primary object of this study was to assess the risk and causes of death in patients with cirrhosis and hepatocellular carcinoma (HCC). Materials and methods From a group of 4,314 patients hospitalized at Jerzy Gromkowski Regional Specialist Hospital in Wroclaw (Poland) due to SARS-CoV-2/COVID-19 infection between March 15, 2020, and January 31, 2022, we selected a cohort of 31 patients with liver cirrhosis (12 women and 19 men) and 7 patients with HCC developed on the cirrhotic liver (1 woman, 6 men). The control group included 123 patients without liver disease. In the entire cohort, we analyzed the course of COVID-19 infection, baseline oxygen demand, liver function (assessed using the CTP—Child-Turoctte-Pugh score and MELD—Model of End-Stage Liver Disease scales), length of hospitalization, development of acute-on-chronic liver failure, and deaths. Results The mean age of the patients was 56.6 years in the liver cirrhosis group, 63.3 years for patients with (HCC) hepatocellular carcinoma, and 64 years in the control group. Time of hospitalization averaged 15.52 days and 11.14 days for patients with liver cirrhosis and liver cancer, respectively. For the control group, the average duration of the hospital stay was 11.61 days. With respect to baseline liver function assessed using the CTP score, in the cirrhosis group 10 patients were CTP class A, 19 patients were class B and 9 patients were class C. The cancer group included 3 patients with class A, 2 patients with class B, and 2 patients with class C. In the studied cohort, 22 patients had a baseline MELD score < 12 points, and in 15 patients was > 12. In the HCC group, it was, respectively, CTP A:3, B: 2, C: 2, and MELD < 12: 3, ≥12: 4 people. Most of these patients presented with a progression of liver disease. Fifteen patients died, including 12 with cirrhosis and 3 with HCC, accounting for 39.47% in the entire cohort, 39% in the cirrhotic group and 43% in the HCC group, and 13 in the control group (10.6%), There was a clear statistical difference between the mortality rate in the group with liver disease and in the control group. Conclusions Infection with SARS-CoV-2/COVID-19 in patients with cirrhosis and HCC tends to have a more severe course and leads to exacerbation of the liver disease. The most common cause of death in the analyzed cohort infected with SARS-CoV-2/COVID-19 was the progression of liver disease, complicated by liver failure.

Liver Damage and COVID-19: At Least a “Two-Hit” Story in Systematic Review

“…In fact, the immune system surveillance of these patients is depressed, also because of malnutrition and subsequent anemia, hypoproteinemia. Altogether, these factors can favor infection by SARS-CoV-2 [ 78 ].…”

“…Molecularly, immunomodulators used for transplanted long-term maintenance are able to down-regulate the second phase of SARS virus infections. In fact, in this step, there is a significant CD4+ T cell count drop, and CD8+ T cell and macrophages reduced function with cytokine cascade and subsequent COVID-19 exacerbation [ 78 ]. Whenever this storm is inhibited by immunosuppressors, there is an elevated viral load with a prolonged disease that can cause increased disease severity in transplant recipients [ 11 , 78 ].…”

“…In addition, calcineurin and mTOR inhibitors can affect the severity of COVID-19 disease. In liver transplants, tacrolimus levels can be significantly elevated by chloroquine co-administration [ 11 , 77 , 78 ].…”

Analysis of the potential relationship between COVID-19 and Behcet’s disease using transcriptome data

“…[51,52] It has been shown that there is a potential relationship between liver carcinoma and COVID-19, and this relationship may be related to the aberrant expression of hub genes Hmox1, TLR4, ALB, TTR, and RBP4. [53] In previous studies, Hmox1 has also been suggested as a novel target for the treatment of autoimmune diseases and it plays an important role in oxidative stress response. [54] In the study of pharmacological treatment of COVID-19, we know that chloroquine and Ridgavir have a good effect on the prevention of COVID-19, while hydroxychloroquine and azithromycin can also stop the replication of the virus.…”

Outcomes of COVID-19 among patients with liver disease

“…An international, multicenter, retrospective, cross-sectional study, including two hundred fifty patients from 38 centers, reported that 18.4% of patients with HCC died within the first 30 d from the onset of COVID-19 symptoms, and that the mortality rate in that period was 20.25% in patients with HCC history and 12.96% in those with de novo HCC[ 78 ]. COVID-19 in HCC patients tends to be more severe and leads to exacerbation of the liver disease[ 79 ]. HCC patients infected with COVID-19 are at a higher risk of complications, ICU admission, and death than the patients without cancer[ 80 ].…”