Öz
Amaç: Sirozu olan ve olmayan kronik karaciğer hastalarında COVID-19’un klinik seyrini ve mortalitesini araştırmak ve sirotik hastalarda COVID’19 sırasında kompansasyon oranlarını belirlemek.
Gereç ve Yöntem: Bu çalışmaya, kronik karaciğer hastalığı olan 96 hasta ile (30 tanesi sirotik) herhangi bir komorbid hastalığı bulunmayan 153 hasta alındı. Bu hasta grupları arasında COVID-19’un şiddeti ve mortalitesi açısından fark olup olmadığı incelendi.
Bulgular: Sirotik hastaların %46,6’sında (14/30) non-sirotik hastaların %15,1’inde (10/66), kronik karaciğer hastalığı olmayan hastaların %12,4’ünde (19/153)’ünde ağır COVID-19 gelişti (p<0.001). Sirotik hastaların %26,6’sında (8/30) ölüm görülmesine rağmen, kronik karaciğer hastalığı olanlarda ölüm oranı %1,3 (2/153) oldu. Sirotik olmayak kronik karaciğer hastalarında ise mortalite görülmedi. Sirotik hastalarda ölüm oranı kontrol grubundaki hastalara göre anlamlı derecede yüksekti (%26,6’ya karşı %1,3; p<0.001). Sirotik hastaların COVID-19 sırasında Child-Pugh skoru 6,4’ten 8’e (p=0.004) MELD skoru ise 10,4’ten 15,8’e yükseldi (p<0.001).
Sonuç: Çalışmamız sonucunda; kronik karaciğer hastalarında, eğer hastanın sirozu yoksa ağır COVID-19 gelişme ve ölüm riskinin karaciğer hastalığı olmayan hastalarla benzer olduğu sonucuna ulaştık. Bu bize korunmuş hepatik rezervin, inflamasyonu tolere edebildiğini gösteriyor. Fakat sirotik hastalarda gelişen COVID-19’un, sirozu olmayan hastalara göre daha ağır seyrettiğini ve mortalitesinin oldukça yüksek olduğunu belirledik. Bu çalışmanın sonuçları bize sirozlu hastalarda COVID-19'un diğer kronik hastalıklarda olduğu gibi mortalite için artmış bir risk faktörü olduğunu gösterdi.
Anahtar Kelimeler
Kaynakça
- Centers for Disease Control and Prevention. Commercial Laboratory Seroprevalence Survey Data. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html
- Wentao N, Xiuwen Y, Deqing Y, Jing B, Ran L, Yongjiu X, Chang H, Haibin W, et al, Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Critical Care (2020) 24:422 https://doi.org/10.1186/s13054-020-03120-0
- Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606.
- Morgan K, Samuel K, Vandeputte M, Hayes PC, Plevris JN. SARS-CoV-2 Infection and the Liver. Pathog (Basel, Switzerland) 2020; 9. https://doi.org/10.3390/pathogens9060430.
- Assante G, Williams R, Youngson NA. Is the increased risk for MAFLD patients to develop severe COVID-19 linked to perturbation of the gut-liver axis? J Hepatol 2020. https://doi.org/10.1016/j.jhep.2020.05.051.
- Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M. COVID-19 and Liver. J Hepatol 2020. https://doi.org/10.1016/j.jhep.2020.06.006.
- Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19- related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020; published online Aug 13. https://doi.org/10.1016/ S2213-8587(20)30271-0.
- Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020; 8: e21.
- Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis, and meta regression. Diabetes Metab Syndr Clin Res Rev 220; 14: 395–403.
- Sarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int 2014; 8: 453–71.
- Clinical management of COVID-19. WHO interim guidance. COVID-19: Clinical care. 2020. https ://www.who.int/publi catio ns/i/item/clini cal management of COVID-19.
- Dong J, Dawei Z, Tieniu Y, Jinsong M, Peng Z, Jing X et al. Effect of COVID‑19 on patients with compensated chronic liver diseases Hepatology International https://doi.org/10.1007/s12072-020-10058-6
- Tapper EB, Sengupta N, Bonder A. The incidence and outcomes of ischemic hepatitis: a systematic review with meta-analysis. Am J Med 2015; 128: 1314–21.
- Thomas M, Andrew MM, Jonathan AC, Sherief AS, Costica A, Matthew JA et all. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study. Journal of Hepatology S0168-8278(20)33667-9 DOI: https://doi.org/10.1016/j.jhep.2020.09.024
- Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020; 94: 91–5. https://doi.org/10.1016/j.ijid.2020.03.017
- Shiv KS, Ashok C, George K.L, Ming‑H.Z, Dong J, Sherief A,Jaeseok H et all. 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) Hepatology International https://doi.org/10.1007/s12072-020-10072-8
- Emma B, Chirag B, Partha K, Andy W, Dominique B, Hassan I et all. Associations of type 1 and type 2 diabetes with COVID-19- related mortality in England: a whole-population study Lancet Diabetes Endocrinol 2020; 8: 813–22 Vol 8 October 2020
- Raymond P, Michael A.L, Ian H, Sunu B.R, Antonia A.L, Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020 Apr-Jun; 21 (2): 1470320320926899. Published online 2020 May 14. doi: 10.1177/1470320320926899
Öz
Aim: The aim of this study; to investigate the clinical course and mortality of COVID-19 in chronic liver patients with and without cirrhosis and to determine decompensation rates during COVID'19 in cirrhotic patients.
Materials and Methods: 96 patients with chronic liver disease (30 of them cirrhosis) and 153 patients without any comorbid disease were included in this study. It was examined whether there was a difference among these patient groups in terms of severity and mortality of COVID-19.
Results: Severe COVID-19 developed in 46.6% (14/30) cirrhotic patients, in 15.1% (10/66) non-cirrhotic patients, and in 12.4% (19/153) patients with no chronic liver disease (p<0.001). Although mortality was seen in 26.7% (8/30) cirrhotic patients and 1.3% (2/153) of the patients with no chronic liver disease, none of the patients in non-cirrhotic group was died. The rate of mortality in the cirrhotic patient group was statistically significantly higher than in the control group (26.6% vs 1.3%; p<0.001). In the patients with cirrhosis, the Child-Pugh score increased from 6.4 to 8 (p=0.004) and the MELD score from 10.4 to 15.8 during the course of COVID-19 (p<0.001).
Conclusion: As a result of our study; we conclude that in patients with chronic liver disease, the risk of developing severe COVID-19 and death is similar to patients without liver disease if the patient does not have cirrhosis. This shows us that preserved hepatic reserve can tolerate inflammation. However, we determined that COVID-19 developing in cirrhotic patients was more severe than in patients without cirrhosis and its mortality was quite high. The results of this study showed us that COVID-19 is an increased risk factor for mortality in patients with cirrhosis, as in other chronic diseases.
Anahtar Kelimeler
COVID-19 chronic liver disease cirrhosis prognosis mortality
Kaynakça
- Centers for Disease Control and Prevention. Commercial Laboratory Seroprevalence Survey Data. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html
- Wentao N, Xiuwen Y, Deqing Y, Jing B, Ran L, Yongjiu X, Chang H, Haibin W, et al, Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Critical Care (2020) 24:422 https://doi.org/10.1186/s13054-020-03120-0
- Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606.
- Morgan K, Samuel K, Vandeputte M, Hayes PC, Plevris JN. SARS-CoV-2 Infection and the Liver. Pathog (Basel, Switzerland) 2020; 9. https://doi.org/10.3390/pathogens9060430.
- Assante G, Williams R, Youngson NA. Is the increased risk for MAFLD patients to develop severe COVID-19 linked to perturbation of the gut-liver axis? J Hepatol 2020. https://doi.org/10.1016/j.jhep.2020.05.051.
- Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M. COVID-19 and Liver. J Hepatol 2020. https://doi.org/10.1016/j.jhep.2020.06.006.
- Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19- related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020; published online Aug 13. https://doi.org/10.1016/ S2213-8587(20)30271-0.
- Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020; 8: e21.
- Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis, and meta regression. Diabetes Metab Syndr Clin Res Rev 220; 14: 395–403.
- Sarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int 2014; 8: 453–71.
- Clinical management of COVID-19. WHO interim guidance. COVID-19: Clinical care. 2020. https ://www.who.int/publi catio ns/i/item/clini cal management of COVID-19.
- Dong J, Dawei Z, Tieniu Y, Jinsong M, Peng Z, Jing X et al. Effect of COVID‑19 on patients with compensated chronic liver diseases Hepatology International https://doi.org/10.1007/s12072-020-10058-6
- Tapper EB, Sengupta N, Bonder A. The incidence and outcomes of ischemic hepatitis: a systematic review with meta-analysis. Am J Med 2015; 128: 1314–21.
- Thomas M, Andrew MM, Jonathan AC, Sherief AS, Costica A, Matthew JA et all. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study. Journal of Hepatology S0168-8278(20)33667-9 DOI: https://doi.org/10.1016/j.jhep.2020.09.024
- Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020; 94: 91–5. https://doi.org/10.1016/j.ijid.2020.03.017
- Shiv KS, Ashok C, George K.L, Ming‑H.Z, Dong J, Sherief A,Jaeseok H et all. 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) Hepatology International https://doi.org/10.1007/s12072-020-10072-8
- Emma B, Chirag B, Partha K, Andy W, Dominique B, Hassan I et all. Associations of type 1 and type 2 diabetes with COVID-19- related mortality in England: a whole-population study Lancet Diabetes Endocrinol 2020; 8: 813–22 Vol 8 October 2020
- Raymond P, Michael A.L, Ian H, Sunu B.R, Antonia A.L, Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020 Apr-Jun; 21 (2): 1470320320926899. Published online 2020 May 14. doi: 10.1177/1470320320926899
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Eylül 2022 |
| Gönderilme Tarihi | 14 Temmuz 2021 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 61 Sayı: 3 |
