Browsing by Author "Kemal Kalista"

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    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)
    (2020-01-01) Shiv Kumar Sarin; Ashok Choudhury; George K. Lau; Ming Hua Zheng; Dong Ji; Sherief Abd-Elsalam; Jaeseok Hwang; Xiaolong Qi; Ian Homer Cua; Jeong Ill Suh; Jun Gi Park; Opass Putcharoen; Apichat Kaewdech; Teerha Piratvisuth; Sombat Treeprasertsuk; Sooyoung Park; Salisa Wejnaruemarn; Diana A. Payawal; Oidov Baatarkhuu; Sang Hoon Ahn; Chang Dong Yeo; Uzziel Romar Alonzo; Tserendorj Chinbayar; Imelda M. Loho; Osamu Yokosuka; Wasim Jafri; Soeksiam Tan; Lau Ing Soo; Tawesak Tanwandee; Rino Gani; Lovkesh Anand; Eslam Saber Esmail; Mai Khalaf; Shahinul Alam; Chun Yu Lin; Wan Long Chuang; A. S. Soin; Hitendra K. Garg; Kemal Kalista; Badamnachin Batsukh; Hery Djagat Purnomo; Vijay Pal Dara; Pravin Rathi; Mamun Al Mahtab; Akash Shukla; Manoj K. Sharma; Masao Omata; The First Affiliated Hospital of Wenzhou Medical University; Institute of Liver and Biliary Sciences; Dongguk University Gyeongju Hospital; Severance Hospital; Kaohsiung Medical University Chung-Ho Memorial Hospital; Mongolian National University of Medical Sciences; Seth GS Medical College and KEM Hospital; Yerevan State Medical University after Mkhitar Heratsi; Universitas Diponegoro; University of Indonesia, RSUPN Dr. Cipto Mangunkusumo; Universitas Indonesia; The Aga Khan University; Thai Red Cross Agency; Lanzhou University; The University of Tokyo; BYL Nair Charitable Hospital & TN Medical College; Kyungpook National University Hospital; Indraprastha Apollo Hospitals; Keimyung University; Manipal Hospital; University of Tanta; Faculty of Medicine, Siriraj Hospital, Mahidol University; Bangabandhu Sheikh Mujib Medical University; Prince of Songkla University; Chiba University; Humanity and Health Clinical Trial Center; Fatima University Medical Center; Liver Transplant Surgery; Fuyang Second People's Hospital; Dharmais National Cancer Hospital; St. Luke's Medical Center-Global City; Hospital Selayang; National Center for Communicable Diseases; Yamanashi Prefectural Central Hospital
    © 2020, Asian Pacific Association for the Study of the Liver. Background and aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Results: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1–3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9–38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3–163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. Conclusions: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.