COVID-19 has been found to be associated with multisystem involvement, depending upon comorbidities. The profile of this new disease in patients with pre-existing chronic liver disease (CLD) is primarily unknown.

Investigators in the present study assessed the liver injury patterns of SARS-CoV-2 in CLD patients, with or without cirrhosis.

Data was obtained from 13 Asian countries on patients with CLD, whether known or newly diagnosed, with confirmed COVID-19.

In all, 228 patients - 185 CLD without cirrhosis and 43 with cirrhosis - were included in the study. Comorbidities were present in about 80% of the patients. Metabolism associated fatty liver disease (61%) and viral etiology (60%) were common. In patients with CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] predisposed to higher risk of liver injury while in cirrhotics, obesity, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury compared to those without these conditions. It was noted that around 43% of CLD patients without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure (11.6%) or acute decompensation (9%). Liver related complications increased (p<0.05) with the stage of liver disease. A Child-Turcotte Pugh score of 9 or more at presentation was shown to predict high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, there was progressive liver injury in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio were the predictors of mortality among patients with cirrhosis. SARS-CoV-2 infection was thus shown to result in significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated ones. CLD patients with diabetes and obesity are more susceptible and should be subjected to close monitoring.

Source: Sarin SK, Choudhury A, Lau GK, et al. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Preprint from Research Square, 19 Jun 2020. DOI: 10.21203/rs.3.rs-36338/v1.