Predictors of in-hospital Outcomes in Patients With Cirrhosis and Coronavirus Disease-2019

Elhence, Anshuman; Vaishnav, Manas; Biswas, Sagnik; Anand, Abhinav; Gunjan, Deepak; Kedia, Saurabh; Mahapatra, Soumya Jagannath; Nayak, Baibaswata; Sheikh, Sabreena; Soni, Kapil Dev; Trikha, Anjan; Goel, Amit; Shalimar, S.

doi:10.1016/j.jceh.2021.10.014

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…Age greater than 70 years as well as a high NACSELD-ACLF score are significantly associated with an increase in mortality in our cohort. Our data also suggest that patients with an increasing number of organ failures have a high mortality with COVID-19, similar to what was reported in several other studies [22,32]. It is difficult to determine whether these organ failures resulted from inflammatory responses due to COVID-19 or due to worsening liver disease.…”

Section: Discussionsupporting

confidence: 83%

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

et al. 2022

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Patients with co-morbidities like cirrhosis are at risk of worse outcome from COVID-19 infection. Given limited prior studies, we evaluated outcomes associated with COVID-19 infection in alcoholic and non-alcoholic steatohepatitis cirrhotic (CC+) versus cirrhotic without COVID-19 (CC−). We performed retrospective analysis of 822,604 patients including 28,610 COVID-19 patients from the National Inpatient Sample database with alcoholic and NASH cirrhosis enrolled between 1 January 2020 to 31 December 2020, with univariate and multivariate regression analyses. Primary outcome was mortality and secondary outcomes was mechanical ventilation, vasopressor use, length of stay, hospitalization expense and predictors of mortality. In-hospital mortality was three time higher in the CC+ group compared to those in the CC− group(18.6% vs. 5.96%, p < 0.001, adjusted odds ratio (OR)3.39 (95% 3.08–3.74 CI). Hospitalization was more likely for underrepresented racial and ethnic groups with COVID-19 and cirrhosis. CC+ group had over twice the rates of mechanical ventilation (19.92% vs. 9.07%, adjusted OR 2.71 2.71 (95% 2.51–2.93 CI)),1.7 times likelihood of receiving vasopressors (4.12% vs. 2.45%, p < 0.001, adjusted OR 1.71 (95% CI 1.46–2.01). COVID-19 is associated with increased mortality in patients with alcoholic and NASH cirrhosis, and patients with alcoholic cirrhosis and COVID-19 have a slightly higher mortality compared to NASH cirrhosis.

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Section: Discussionsupporting

confidence: 83%

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

et al. 2022

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“…24 Adults with underlying cirrhosis have been shown to be at increased risk of contracting COVID-19, and to have worse outcomes. [25][26][27] Our study is mainly limited by the patient size for measured ACE2 expression, which prevents matching for possible confounding patient variables that can affect ACE2 levels. Its analysis is strengthened by being able to determine expression on the single-cell level such that 1 sample provides hundreds of data points for the presence of ACE2.…”

Section: Discussionmentioning

confidence: 99%

“…The authors of that paper hypothesize that this finding is related to a presumed increased hepatic ACE2 expression in these children 24. Adults with underlying cirrhosis have been shown to be at increased risk of contracting COVID-19, and to have worse outcomes 25–27…”

Section: Discussionmentioning

confidence: 99%

Angiotensin-converting Enzyme-2 (ACE2) Expression in Pediatric Liver Disease

Stevens

Kolachala

Joshi

et al. 2022

Applied Immunohistochemistry &Amp; Molecular Morphology

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The membrane protein angiotensin-converting enzyme-2 (ACE2) has gained notoriety as the receptor for severe acute respiratory syndrome coronavirus 2. Prior evidence has shown ACE2 is expressed within the liver but its function has not been fully discerned. Here, we utilized novel methodology to assess ACE2 expression in pediatric immune-mediated liver disease to better understand its presence in liver diseases and its role during infections such as COVID-19. We stained liver tissue with ACE2-specific immunofluorescent antibodies, analyzed via confocal microscopy. Computational deep learning-based segmentation models identified nuclei and cells, allowing the quantification of mean cellular and cytosolic immunofluorescent. Spatial transcriptomics provided high-throughput gene expression analysis in tissue to determine cellular composition for ACE2 expression. ACE2 plasma expression was quantified via enzyme-linked immunosorbent assay. High ACE2 expression was seen at the apical surface of cholangiocytes, with lower expression within hepatocyte cytosol and nonparenchymal cells (P < 0.001). Children with liver disease had higher ACE2 hepatic expression than pediatric control tissue (P < 0.001). Adult control tissue had higher expression than pediatric control (P < 0.001). Plasma ACE2 was not found to be statistically different between samples. Spatial transcriptomics identified cell composition of ACE2-expressing spots containing antibody-secreting cells. Our results show ACE2 expression throughout the liver, with strongest localization to cholangiocyte membranes. Machine learning can be used to rapidly identify hepatic cellular components for histologic analysis. ACE2 expression in the liver may be increased in pediatric liver disease. Future work is needed to better understand the role of ACE2 in chronic disease and acute infections.

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“…DAAs may not be effective for all patients with HCV infection and ACLF [ 126 ]. In the DAA era, however, as HCV infection may occasionally be associated with ACLF, which could lead to poor survival [ 125 , 126 , 127 , 128 , 129 ], we also focused on HCV acute exacerbation and ALT flare in this article. Although there are several excellent reviews about acute exacerbation and alanine aminotransferase flare in HCV carrier patients [ 77 , 86 ], we added the recent literature and reports in this review.…”

Section: Hepatitis B Virus (Hbv) Reactivation In Patients Treated Wit...mentioning

confidence: 99%

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

Matsumoto

Ishii

Arima

et al. 2023

Viruses

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The hepatitis C virus (HCV) causes acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma, as well as extrahepatic manifestations such as malignant lymphoma. Currently, direct-acting antiviral agents (DAAs) against HCV infection can lead to a sustained virological response (SVR) in almost all HCV-infected patients. In this review article, we discuss acute exacerbation and alanine aminotransferase (ALT) flare in patients with chronic HCV infection. Although acute liver failure caused by HCV infection is rare, careful attention should be paid to the cases with ALT elevation during the natural course of chronic HCV infection. HCV genotype 2 infection, the use of rituximab, and a higher dose of corticosteroid are factors associated with HCV acute exacerbation and ALT flare. Treatment regimens for cancer have been interrupted or changed due to ALT flare due to HCV infection in some patients undergoing chemotherapy for cancer. The pathogenesis of HCV acute exacerbation and ALT flare could involve cellular as well as humoral immune responses. In the DAA era, the earlier introduction of DAAs may prevent chronic HCV-infected patients with acute exacerbation and ALT flare from developing into a more severe form, although DAAs may not be effective for all of them.

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Predictors of in-hospital Outcomes in Patients With Cirrhosis and Coronavirus Disease-2019

Cited by 13 publications

References 19 publications

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database

Angiotensin-converting Enzyme-2 (ACE2) Expression in Pediatric Liver Disease

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

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