Advanced liver disease: It is not all about Covid-19

Abstract

Patients with advanced chronic liver disease may be at increased risk of infection and/or severe course due to the cirrhosis-associated immune dysfunction. However, there is limited data linking chronic liver disease and Covid-19. Patients with cirrhosis are known to have abnormalities of immune function (immunodeficiency), as well as systemic inflammation, which is the pathophysiological hallmark of increased susceptibility to infection. Patients with cirrhosis are at a high risk of having a severe course of the influenza, including the development of organ failures. However, there is limited data on the course of Covid-19 in patients with chronic liver disease (CLD) and whether SARS-Cov2 can increase the risk of decompensation or development of acute-on-chronic liver failure (ACLF). Actual data indicates a prevalence (0-11%) of pre-existing liver conditions in patients with COVID-19. We present two cases of patients with decompensated liver disease that were evaluated for the SARS-Cov2 due to the new hospital policy of testing all patients who require hospital admission. One of them was asymptomatic, while the other presented mild respiratory symptoms. We believe that COVID-19 did not worsen liver function in our patients, and as such did not increase their risk of mortality or develop ACLF during admission.