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Original Research—Clinical|Articles in Press

Differential Effects of COVID-19 Hospitalization on the Trajectory of Liver Disease Progression

  • Dilara Hatipoğlu
    Affiliations
    Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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  • Connor Mulligan
    Affiliations
    Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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  • Jeffrey Wang
    Affiliations
    Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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  • Juan Peticco
    Affiliations
    Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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  • Reid Grinspoon
    Affiliations
    Harvard Medical School, Boston, MA, USA
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  • Sanjay Gadi
    Affiliations
    Harvard Medical School, Boston, MA, USA
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  • Camilla Mills
    Affiliations
    Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
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  • Jay Luther
    Affiliations
    Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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  • Raymond T. Chung
    Correspondence
    Correspondence: Raymond T. Chung, MD, Liver Center, GI Division, Massachusetts General Hospital, Boston, MA 02114,
    Affiliations
    Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Open AccessPublished:February 12, 2023DOI:https://doi.org/10.1016/j.gastha.2023.01.020
Differential Effects of COVID-19 Hospitalization on the Trajectory of Liver Disease Progression
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      Abstract:

      Background and Aims

      Patients with chronic liver disease (CLD) were significantly affected by COVID-19. Despite evidence of acute hepatic injury and increased mortality, the long-term effects of COVID-19 hospitalization on the natural history of CLD patients is unknown.

      Methods

      The Massachusetts General Hospital COVID-19 registry was used to obtain a cohort of CLD patients hospitalized between March 8 and June 3, 2020. The Partners Research Patient Data Registry (RPDR) was used to develop a matched CLD patient control list without COVID-19. FIB-4, NAFLD Fibrosis score (NFS), and MELD-Na scores were calculated pre-, day of, and 1-year post-discharge from admission. Unpaired T-test was used to compare continuous variables.

      Results

      Fifty-two COVID-19 patients and 92 control patients with CLD were included. Patients with non-cirrhotic CLD who were hospitalized for COVID-19 had an acute rise in FIB-4 on admission with subsequent improvement on one year follow up demonstrating no difference in progression of liver disease compared to the controls (p = 0.87, CI -0.088 to 0.048). Similar trends were observed in NAFLD patients using NFS (p = 0.48, CI -0.016 to 0.023). In contrast, patients with cirrhosis experienced rise in MELD-Na post-admission compared to the control cirrhosis group (0.35 vs -0.076/month; p = 0.04, CI -0.827 to -0.025), suggesting a potential for long-term consequences of COVID-19.

      Conclusion

      Non-cirrhotic CLD patients who survive COVID-19 hospitalization do not appear to have change in FIB-4, NFS scores at one year. However, patients with cirrhosis exhibit increasing MELD-Na one-year post-COVID suggesting a differential effect of acute COVID-19 on the trajectory of established cirrhosis.

      Keywords

      Abbreviations:

      AUD (Alcohol Use Disorder), CLD (Chronic Liver Disease), FIB-4 (Fibrosis-4 Index), MELD-NA (Model for End-Stage Liver Disease/Na Score), NAFLD (Non-Alcoholic Fatty Liver Disease), NFS (Non-Alcoholic Fatty Liver Disease Fibrosis score)

      Article info

      Publication history

      Accepted: January 27, 2023
      Received in revised form: January 25, 2023
      Received: August 26, 2022

      Publication stage

      In Press Accepted Manuscript

      Footnotes

      Data Transparency Statement: Data, analytic methods, and study materials will not be available to other researchers.

      Authors’ Contributions:

      Dilara Hatipoglu: Conceptualization, Data Curation, Methodology, Formal Analysis, Writing, Review & Editing

      Connor Mulligan: Data Curation, Writing – Reviewing & Editing

      Jeffrey Wang: Data Curation

      Juan Peticco: Data Curation

      Reid Grinspoon: Data Curation, Review & Editing

      Camilla Mills: Data Curation, Review & Editing

      Jay Luther: Review & Editing

      Raymond T Chung: Conceptualization, Methodology, Formal Analysis, Writing, Review & Editing

      Funding: RTC was supported by NIH U19AI082630 and the MGH Research Scholars Program.

      Conflicts of Interest: The authors disclose no conflicts.

      Ethical Statement: The corresponding author, on behalf of all authors, jointly and severally, certifies that their institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.

      Reporting Guidelines: SAGER, STROBE

      Identification

      DOI: https://doi.org/10.1016/j.gastha.2023.01.020

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of the AGA Institute.

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