INFLUENCE OF PRE-EXISTING LIVER DISEASE IN THE COURSE OF COVID-19. IN AN AREA WITH LOW INCIDENCE OF SARS-Cov2 INFECTION

Background: Some comorbidities have been associated with a negative impact in the severity of COVID-19 course Patients with advanced chronic liver disease (CLD) may be at increased risk of severe course due to the cirrhosisassociated immune dysfunction However the actual data is scare The aim of our study was to determine the prevalence of CLD in COVID-19 patients and to analyse the course of the infection comparing with patients with non-liver disease Methods: This was a retrospective single centre study in which we included all positive SARS-Cov2 polymerase chainreactions (PCR) from March 23 2020 to April 30 2020 Clinical and biochemical data of patients with and without CLD and COVID-19 were collected using medical records Results: 447 patients with SARS-Cov2 PCR were included, 6 3% had CLD 69 7% of patients with CLD were male, with a median age of 65 5 years, with active alcohol and smoke use 75% had non-advanced liver fibrosis, most of them NAFLD Patients with advanced liver fibrosis were younger, with a mean age of 58 (SD 9 69) years, underlying COPD (57 2%) Meanwhile patients with CLD without advanced liver fibrosis were older, with a mean age of 68 (SD 12 08) years, and had multiples comorbidities like hypertension in 71 4% and diabetes in 47 6% Hospital admission rate (92 9% vs 47 7% p<0 001) was higer in patients with CLD than those without CLD Concomitant comorbidities (diabetes 38 5 vs 16 5% p=0 011;obesity 30 8 vs 8 5% p=0 033;cancer 23 1 vs 5% p=0 027 and COPD 19 2 vs 9% p=0 009), and concomitant antibiotics treatment (19 3 vs 5%;p= 0 018) were higher in patients with CLD than those without CLD The rate of intesive care admission, respiratory support (invasive mechanical ventilation 7 7 vs 9 5% p=0 055;and continuous positive airway pressure CPAP or non-invasive positive pressure 19 2 vs 19 0% p=0 577) and median stay length (8 (5-15) vs 7 (5-13) p=0 696) were similar in both groups Mortality rate was similar in patients with and without CLD (30 8 vs 19 6% p=0 289) However, in the univariate analysis male (OR= 11 20;95% IC= 1 25-100 31;p=0 031);presence of obesity (OR= 7 20;95% CI= 1 13-45 96;p=0 037), antibiotics concomitant treatment (OR= 12;95% CI= 1 95 -73 97;p=0 007);and presence of COPD (OR=5 25 95% CI= 1-254 9 p=0 050) in multivariate analysis were associated with mortality in patients with CLD 87 5% patients with CLD died due to respiratory failure In the general mortality analysis;CLD was not a risk factor associated with mortality (OR= 1 06;95% CI= 0 35-3 18;p=0 924) like the cardiovascular diseases ( Coronary artery disease OR= 4 95;95% CI 1 51-16 27;p=0 008 and Congestive heart failure OR= 5 66;95% CI= 1 64-19 54;p=0 006) Conclusion: Patients with CLD had a low incidence of SARS-Cov2 infection, but higher risk of hospital admission with worse outcomes associated to other concomitant comorbidities and advanced fibrosis