Manifestations of SARS-COV-2 in patients with chronic liver disease

Introduction and Objectives

This study aimed to analyze the degree of severity of SARS-CoV-2 infection in patients with the previous chronic liver disease through clinical, laboratory and histological variables.

Materials and Methods

From November 2021 to July 2021, at the Valentín Gómez Farías Hospital, a Gastroenterology service, 70 patients were treated with prior informed consent and endorsed by the ethics committee. For this study, 51 individuals with chronic liver disease and diagnosis of SARS-CoV-2 were included: 25 with steatohepatitis and 26 with liver cirrhosis. The following findings were observed:

Results

Histological findings:

• Micro vesicular steatosis.

• Mild mortal and lobular inflammatory activity.

• High viral load in the vascular endothelium (48 to 53%) and cytopathic effect of the SARS-CoV-2 virus.

• Ischemia due to hypoperfusion mainly due to myocardial injury.

• Immune hyperactivation.

• Drug-reactive liver injury.

• Apoptosis

Discussion

The COVID-19 pandemic is more severe in vulnerable patients, mainly older adults, male gender and comorbidities such as hypertension, diabetes, nephropathy, heart disease, lung disease, immunosuppression and patients with liver disease. Of these, 60% have severe symptoms and a mortality of 34%.

Conclusions

COVID-19 is the leading cause of death in Mexico. High-risk entities in this viremia are of great global prevalence. Steatohepatitis (NASH) and liver cirrhosis predispose high mortality and complications, possibly evidenced by these clinical evaluations and hepatic laboratory tests.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.

Table 1. Demographic, biochemical and symptomatology characteristics of the two groups

Previous pathologies	Steatohepatitis	Liver cirrhosis
Age	55.64	60,84
Gender	72% women - 28% men	42% women – 58% men
BMI	30.76	27.84
Comorbidities
Overweight/obesity	100%	100%
DM 2	31%	20%
Alcoholism	0%	27%
Autoimmune disease	0%	4%
Laboratory
AST	42.24	56.76
ALT	50.25	69.90
DHL	308.2	315.6
Platelets	170	100.38
Ferritin	496.24	592.5
D-dimer	530.54	1,064
Lymphocytes	35.2	29.96
ESR	32.32	30.06
PCR	49	47.03
Oxygen saturation	85.24	85.69
Clinic:
Cough	16 (64%)	14 (54%)
Dyspnea	13 (52%)	12 (46%)
Pneumonia	5 (20%)	8 (32%)
Asthenia	6 (24%)	6 (24%)
Fever	2 (8%)	13 (52%)
Headache	3 (12%)	8 (31%)
Anosmia	1 (4%)	1 (4%)
Shivers	1 (4%)	1 (4%)
Arthralgia	3 (12%)	2 (8%)
Diarrhea	1 (4%)	2 (8%)