Cytokine storm is a common finding in patients with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The present study evaluated the incidence of acute on chronic liver failure (ACLF) in COVID-19 patients with pre-existing compensated chronic liver disease (CLD).

The researchers’ appraised 140 consecutive COVID-19 patients admitted From 20 Jan 2020 to 7 Feb 2020. Examination of pre-existing CLD including those with liver cirrhosis were done by APRI/FIB-4 score and /or ultrasound; NAFLD was diagnosed by either ultrasound or hepatic steatosis index with significant liver fibrosis and chronic hepatitis B (CHB) or hepatitis C (CHC) infection. The diagnosis, grading of severity and clinical management of COVID-19 patients adhered to the guideline and clinical protocol issued by the National Health Commission. Liver function test of all patients were performed at least twice weekly till discharge with full recovery or death.

The results showed that out of all patients, 3 had liver cirrhosis, 6 patients had CHB, 13 had NAFLD with significant liver fibrosis (one also had CHB). No patient had liver decompensation on admission. Worsening of COVID-19 disease was remarkably less common in non-CLD patients (10/118, 8.5%) than CLD patients (13/22, 59.1%). One patient with CLD had acute-on-chronic liver failure (ACLF).

Thus, the study concluded that progression of disease is substantially higher in COVID-19 patients with CLD in contrast to those with no CLD. Reports also shows that ACLF can also be seen in patient with pre-existing compensated CLD who had severe COVID-19.

Source: Ji D, Zhang D, Yang T, Mu J, Zhao P, Xu J, Li C, Cheng G, Wang Y, Chen Z, Qin E, Lau G. Effect of COVID-19 on patients with compensated chronic liver diseases. Hepatol Int. 2020 Sep;14(5):701-710.