Metabolic Liver Research Program

COVID-19 and the liver a hepatologist´s perspective

Jörn M. Schattenberg, MD

University Medical Center Mainz, Germany

Metabolic Liver Research Program

CURRENT (EARLY) EVIDENCE

EU Covid19 Clinicians Network Webinar

2

Metabolic Liver Research Program

Evidence on liver injury in COVID-19

Alqahtani SA & Schattenberg JM UEG Journal 2020

Consider Underlying Liver Disease

Metabolic Liver Research Program

Liver injury and COVID-19

4

Cytotoxicity from viral infection

Inflammation and drug-induced

Severe >3x ULN

44 consecutive patients admitted with confirmed COVID-19 (Mainz, Germany)

68 years [range, 23-86 years] 68% male mean oxygen 90.3 % (range 74-99%) respiratory rate 17/min (range 12-

25/min). mean hospital stay was 7.2 days

two patients discharged within 24 hours

13 (29.5%) requiring ICU

Schattenberg, Labenz et al. UEG Journal May 2020

ASTALT

Metabolic Liver Research Program

Observations from admitted cases

5

Metabolic Liver Research Program

Clinical characteristics, hepatic steatosis and fibrosis

6

N=30 (%)

Male sex 17 (56,7)

Median age (range) 72 (28-99)

Median AST (U/l) (min;max) 51 (28; 404)

Median ALT (U/l) (min; max) 27 (6; 784)

Any (social) alcohol use – no. (%) 15 (50)

Obesity (BMI > 30) 12 (40)

Reported preexisting Liver Disease – no. (%) 1 (3,3)

Diabetes mellitus Typ 2 – no. (%) 10 (33,3)

HLP – no. (%) 14 (46,7)

Arterielle Hypertonie – no. (%) 20 (66,7)

Required ICU – no. (%) 5 (16,7)

Death – no. (%) 3 (10)

>F1 8.2 kPa

5/30 (16.7%)

Cut-offs according to Eddowes PJ, et al. Gastroenterology. 2019;156(6):1717-1730

Shmanko, Schattenberg unpublished data

Metabolic Liver Research Program

Liver injury in COVID-19

Alqahtani SA & Schattenberg JM UEG Journal 2020

Metabolic Liver Research Program

Discussion in the literature

8

2. Based on the above perspectives, we feel that

raised liver aminotransferases associated with SARS-

CoV-2 positivity are more likely attributable to illness

severity, in which host response and iatrogenic harm

(i.e. drugs, ventilation) drive bystander liver injury….

1. Cai Q, et al. J Hepatol. 2020.2. Bangash MN, et al. J Hepatol. 2020.3. Vespa E, et al. J Hepatol. 2020.

3. In conclusion, we think that although LFTs

alterations are common in hospitalized Covid-19

patients, it is still unclear whether they carry any

prognostic value.

1.

Metabolic Liver Research ProgramPre-Existing Liver Disease EASL Recommendations

9Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID Position Paper

Liver cirrhosis is expected to be a risk

factor for a severe COVID-19 course

Metabolic Liver Research Program

End-stage Liver disease and the risk of ACLF in viral infection

10Schutte A, et al. J Hepatol. 2019;70(4):797-799

no difference in number of comorbidities more severe course of influenza than patients without liver disease (higher maximal organ failure scores) risk of secondary bacterial infections significantly higher for liver cirrhosis compared to no liver disease (82% vs. 24%,

p = 0.001).

Metabolic Liver Research Program

Summary and Q&A

• Early data on liver injury

– Mostly cytotoxicity in a generalized inflammatory state of COVID-19

– Severe cases can exhibit ‚cytokine storm/immune activation‘

– Hepatic involvement in non-liver diseased populations appears to be no major concern

Prospective Data on patients with chronic liver disease required

E-Mail: joern.schattenberg@unimedizin-mainz.de

Follow on Twitter: @schattenbergJ

11