BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with p...BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.METHODS This multicenter,retrospective cohort study included all cases of confirmed coinfection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals(Al-Sahel Hospital,Al-Matareya Hospital,Al-Ahrar Hospital,Ahmed Maher Teaching Hospital,Al-Gomhoreya Hospital,and the National Hepatology and Tropical Medicine Research Institute)affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt.Patients were recruited from May 1,2020,to July 31,2020.Demographic,laboratory,imaging features,and outcomes were collected.Multivariate regression analysis was performed to detect factors affecting mortality.RESULTS This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection,of which 64(51.20%)had liver cirrhosis and 40(32.00%)died.Fever,cough,dyspnea,and fatigue were the most frequent symptoms in patients with liver cirrhosis.Cough,sore throat,fatigue,myalgia,and diarrhea were significantly more common in patients with liver cirrhosis than in noncirrhotic patients.There was no difference between patients with and without cirrhosis regarding comorbidities.Fifteen patients(23.40%)with liver cirrhosis presented with hepatic encephalopathy.Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans:28(43.75%)vs 4(6.55%),respectively(P value<0.001).These patients also were more likely to have severe COVID-19 infection,compared to patients without liver cirrhosis:29(45.31%)vs 11(18.04%),respectively(P value<0.003).Mortality was higher in patients with liver cirrhosis,compared to those with no cirrhosis:33(51.56%)vs 9(14.75%),respectively(P value<0.001).All patients in Child-Pugh class A recovered and were discharged.Cirrhotic mortality occurred among decompensated patients only.A multivariate regression analysis revealed the following independent factors affecting mortality:Male gender(OR 7.17,95%CI:2.19–23.51;P value=0.001),diabetes mellitus(OR 4.03,95%CI:1.49–10.91;P value=0.006),and liver cirrhosis(OR 1.103,95%CI:1.037–1.282;P value<0.0001).We found no differences in liver function,COVID-19 disease severity,or outcomes between patients who previously received direct-acting antiviral therapy(and achieved sustained virological response)and patients who did not receive this therapy.CONCLUSION Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19.Male gender,diabetes mellitus,and liver cirrhosis are independent factors associated with increased mortality risk.展开更多
BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 ...BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.展开更多
During the early phase of the coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),diagnosis was difficult due to the diversity in symptoms and imaging findi...During the early phase of the coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),diagnosis was difficult due to the diversity in symptoms and imaging findings and the variability of disease presentation.Pulmonary manifestations are reportedly the main clinical presentations of COVID-19 patients.Scientists are working hard on a myriad of clinical,epidemiological,and biological aspects to better understand SARS-CoV-2 infection,aiming to mitigate the ongoing disaster.Many reports have documented the involvement of various body systems and organs apart from the respiratory tract including the gastrointestinal,liver,immune system,renal,and neurological systems.Such involvement will result in diverse presentations related to effects on these systems.Other presentations such as coagulation defects and cutaneous manifestation may also occur.Patients with specific comorbidities including obesity,diabetes,and hypertension have increased morbidity and mortality risks with COVID-19.展开更多
Since the discovery of severe acute respiratory syndrome coronavirus 2(SARSCoV-2)and its resultant coronavirus disease 2019(COVID-19)pandemic,respiratory manifestations have been the mainstay of clinical diagnosis,lab...Since the discovery of severe acute respiratory syndrome coronavirus 2(SARSCoV-2)and its resultant coronavirus disease 2019(COVID-19)pandemic,respiratory manifestations have been the mainstay of clinical diagnosis,laboratory evaluations,and radiological investigations.As time passed,other pathological aspects of SARS-CoV-2 have been revealed.Various hemostatic abnormalities have been reported since the rise of the pandemic,which was sometimes superficial,transient,or fatal.Mild thrombocytopenia,thrombocytosis,venous,arterial thromboembolism,and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19.Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19,especially in patients admitted to intensive care units.Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation.Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood,professional societies recommend prophylactic antithrombotic therapy in severe cases,especially in the presence of abnormal coagulation indices.The review article discusses the various available evidence on coagulation disorders,management strategies,outcomes,and prognosis associated with COVID-19 coagulopathy,which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.展开更多
文摘BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.METHODS This multicenter,retrospective cohort study included all cases of confirmed coinfection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals(Al-Sahel Hospital,Al-Matareya Hospital,Al-Ahrar Hospital,Ahmed Maher Teaching Hospital,Al-Gomhoreya Hospital,and the National Hepatology and Tropical Medicine Research Institute)affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt.Patients were recruited from May 1,2020,to July 31,2020.Demographic,laboratory,imaging features,and outcomes were collected.Multivariate regression analysis was performed to detect factors affecting mortality.RESULTS This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection,of which 64(51.20%)had liver cirrhosis and 40(32.00%)died.Fever,cough,dyspnea,and fatigue were the most frequent symptoms in patients with liver cirrhosis.Cough,sore throat,fatigue,myalgia,and diarrhea were significantly more common in patients with liver cirrhosis than in noncirrhotic patients.There was no difference between patients with and without cirrhosis regarding comorbidities.Fifteen patients(23.40%)with liver cirrhosis presented with hepatic encephalopathy.Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans:28(43.75%)vs 4(6.55%),respectively(P value<0.001).These patients also were more likely to have severe COVID-19 infection,compared to patients without liver cirrhosis:29(45.31%)vs 11(18.04%),respectively(P value<0.003).Mortality was higher in patients with liver cirrhosis,compared to those with no cirrhosis:33(51.56%)vs 9(14.75%),respectively(P value<0.001).All patients in Child-Pugh class A recovered and were discharged.Cirrhotic mortality occurred among decompensated patients only.A multivariate regression analysis revealed the following independent factors affecting mortality:Male gender(OR 7.17,95%CI:2.19–23.51;P value=0.001),diabetes mellitus(OR 4.03,95%CI:1.49–10.91;P value=0.006),and liver cirrhosis(OR 1.103,95%CI:1.037–1.282;P value<0.0001).We found no differences in liver function,COVID-19 disease severity,or outcomes between patients who previously received direct-acting antiviral therapy(and achieved sustained virological response)and patients who did not receive this therapy.CONCLUSION Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19.Male gender,diabetes mellitus,and liver cirrhosis are independent factors associated with increased mortality risk.
文摘BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.
文摘During the early phase of the coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),diagnosis was difficult due to the diversity in symptoms and imaging findings and the variability of disease presentation.Pulmonary manifestations are reportedly the main clinical presentations of COVID-19 patients.Scientists are working hard on a myriad of clinical,epidemiological,and biological aspects to better understand SARS-CoV-2 infection,aiming to mitigate the ongoing disaster.Many reports have documented the involvement of various body systems and organs apart from the respiratory tract including the gastrointestinal,liver,immune system,renal,and neurological systems.Such involvement will result in diverse presentations related to effects on these systems.Other presentations such as coagulation defects and cutaneous manifestation may also occur.Patients with specific comorbidities including obesity,diabetes,and hypertension have increased morbidity and mortality risks with COVID-19.
文摘Since the discovery of severe acute respiratory syndrome coronavirus 2(SARSCoV-2)and its resultant coronavirus disease 2019(COVID-19)pandemic,respiratory manifestations have been the mainstay of clinical diagnosis,laboratory evaluations,and radiological investigations.As time passed,other pathological aspects of SARS-CoV-2 have been revealed.Various hemostatic abnormalities have been reported since the rise of the pandemic,which was sometimes superficial,transient,or fatal.Mild thrombocytopenia,thrombocytosis,venous,arterial thromboembolism,and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19.Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19,especially in patients admitted to intensive care units.Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation.Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood,professional societies recommend prophylactic antithrombotic therapy in severe cases,especially in the presence of abnormal coagulation indices.The review article discusses the various available evidence on coagulation disorders,management strategies,outcomes,and prognosis associated with COVID-19 coagulopathy,which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.
