Shiv Kumar SarinAshok ChoudhuryGeorge K. LauMing Hua ZhengDong JiSherief Abd-ElsalamJaeseok HwangXiaolong QiIan Homer CuaJeong Ill SuhJun Gi ParkOpass PutcharoenApichat KaewdechTeerha PiratvisuthSombat TreeprasertsukSooyoung ParkSalisa WejnaruemarnDiana A. PayawalOidov BaatarkhuuSang Hoon AhnChang Dong YeoUzziel Romar AlonzoTserendorj ChinbayarImelda M. LohoOsamu YokosukaWasim JafriSoeksiam TanLau Ing SooTawesak TanwandeeRino GaniLovkesh AnandEslam Saber EsmailMai KhalafShahinul AlamChun Yu LinWan Long ChuangA. S. SoinHitendra K. GargKemal KalistaBadamnachin BatsukhHery Djagat PurnomoVijay Pal DaraPravin RathiMamun Al MahtabAkash ShuklaManoj K. SharmaMasao OmataThe First Affiliated Hospital of Wenzhou Medical UniversityInstitute of Liver and Biliary SciencesDongguk University Gyeongju HospitalSeverance HospitalKaohsiung Medical University Chung-Ho Memorial HospitalMongolian National University of Medical SciencesSeth GS Medical College and KEM HospitalYerevan State Medical University after Mkhitar HeratsiUniversitas DiponegoroUniversity of Indonesia, RSUPN Dr. Cipto MangunkusumoUniversitas IndonesiaThe Aga Khan UniversityThai Red Cross AgencyLanzhou UniversityThe University of TokyoBYL Nair Charitable Hospital &amp; TN Medical CollegeKyungpook National University HospitalIndraprastha Apollo HospitalsKeimyung UniversityManipal HospitalUniversity of TantaFaculty of Medicine, Siriraj Hospital, Mahidol UniversityBangabandhu Sheikh Mujib Medical UniversityPrince of Songkla UniversityChiba UniversityHumanity and Health Clinical Trial CenterFatima University Medical CenterLiver Transplant SurgeryFuyang Second People's HospitalDharmais National Cancer HospitalSt. Luke's Medical Center-Global CityHospital SelayangNational Center for Communicable DiseasesYamanashi Prefectural Central Hospital2020-08-252020-08-252020-01-01Hepatology International. (2020)19360541193605332-s2.0-85087508326https://repository.li.mahidol.ac.th/handle/20.500.14594/58345© 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.Mahidol UniversityMedicineArticleSCOPUS10.1007/s12072-020-10072-8