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

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.