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1
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Zhao H, Li Y, Tian P, Sun W, Luo Y, Zhang X, Li J, Gong T, Yang Z, Song P, Li X. Efficacy and prognostic factors of COVID-19 vaccine in patients with hepatocellular carcinoma: Analysis of data from a prospective cohort study. Cancer Med 2024; 13:e70068. [PMID: 39119737 PMCID: PMC11310663 DOI: 10.1002/cam4.70068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 06/21/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The efficacy of coronavirus disease 2019 (COVID-19) vaccines in preventing SARS-CoV-2 infection in patients with hepatocellular carcinoma (HCC) is not clear. METHODS From January 2022 to October 2022, patients diagnosed with HCC in a prospective, multicenter, observational cohort were analyzed. RESULTS One hundred and forty-one patients with (n = 107) or without COVID-19 vaccination (n = 34) were included. The number of patients with severe or very severe infection was relatively lower in the vaccinated group (3.7% vs. 11.8%, p = 0.096). Median infection-free survival in the vaccinated group (14.0 vs. 8.3 months, p = 0.010) was significantly longer than that in the unvaccinated group. COVID-19 vaccination (hazard ratio (HR) HR = 0.47), European Cooperative Oncology Group performance score = 0 (HR = 2.06), and extrahepatic spread (HR = 0.28) were found to be the independent predictive factors for infection-free survival. CONCLUSION COVID-19 vaccines could effectively reduce the SARS-Cov-2 infection in patients with HCC.
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Affiliation(s)
- He Zhao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Interventional Therapy, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital and Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenChina
| | - Ying Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Pengfei Tian
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wei Sun
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yingen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaowu Zhang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jingui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tao Gong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhengqiang Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Interventional TherapyFirst Hospital of China Medical UniversityShenyangChina
| | - Peng Song
- Department of Interventional Therapy, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital and Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenChina
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Elzouki ANY, Elshafei MN, Aziz A, Elzouki I, Waheed MA, Farooqui K, Azad AM, Habas E, Danjuma MHI. Seroconversion and safety of Covid-19 vaccines in pa-tients with chronic liver disease and liver transplant: A systematic review. Qatar Med J 2023; 2023:21. [PMID: 38089670 PMCID: PMC10714019 DOI: 10.5339/qmj.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/30/2023] [Indexed: 01/03/2025] Open
Abstract
BACKGROUND AND AIMS As part of the COVID-19 control strategy, a growing number of vaccine portfolios evolved and got fast-tracked through regulatory agencies, with a limited examination of their efficacy and safety in vulnerable populations, such as patients with chronic conditions and immunocompromised states. Patients with chronic liver disease (CLD), and cohorts post liver transplant (LT) in particular, were underrepresented in the determinant trials of vaccine development, hence the paucity of data on their efficacy and safety in published literature. This systematic review aims to examine the available evidence and ascertain the effectiveness and safety of Covid-19 vaccination in patients with CLD and those with LT. METHODS A systematic review of PubMed (Medline), Google Scholar, Cochrane Library, and ScienceDirect from inception until 1st March 2022 was conducted. We included observational studies and assessed vaccine efficacy regarding seroconversion or immunological rate, whereas serious or significant adverse effects have been considered safety outcomes when reported. RESULTS Studies comprised 45275 patients, performed in 11 different countries. Seroconversion or immunological rate after Covid-19 vaccination was mostly the primary endpoint, whereas other endpoints like covid-19 related adverse effects were also reported. Twenty-four of the final analyzed studies are prospective cohort studies, while four are retrospective cohort studies. Twenty-one studies included patients who underwent LT and received the Covid vaccine; nine included patients who had CLD due to various etiologies. The median age range of all included patients varied from 43-69 years. All patients with LT who received at least two doses of Covid vaccine had a seroconversion rate of around 60%. Patients with CLD had a seroconversion rate of about 92% post two doses of Covid vaccination. The average seroconversion rate in post-transplant recipients was around 45% after two doses of the significant Covid vaccines: Pfizer, AstraZeneca, Moderna, and Jansen. Only two studies have reported a higher seroconversion rate of 75% and 73% after the third dose of Covid vaccine. No significant adverse effects were reported in all studies; the most commonly reported negative effect was local injection site pain. CONCLUSION The present systematic review, comprising real-world observational data studies, concludes that Covid-19 vaccination was associated with 92% and 60% seroconversion rates in patients with CLD and LT, respectively. No significant side effects were reported in all studies. This finding helps to resolve the uncertainty associated with Covid-19 vaccination in this cohort of patients.
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Affiliation(s)
- Abdel-Naser Y Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Nabil Elshafei
- Department of Clinical Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Afia Aziz
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
| | - Islam Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
| | - Muhammad Aamir Waheed
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
| | - Khalid Farooqui
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
| | - Aftab Mohammed Azad
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Elmukhtar Habas
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
| | - Mo-Hammed I Danjuma
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: ORCID ID: 000-0002-9132-1752
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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3
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Cheung KS, Lam LK, Mao X, Tan JT, Ooi PH, Zhang R, Chan KH, Hung IFN, Seto WK, Yuen MF. Effect of Moderate to Severe Hepatic Steatosis on Vaccine Immunogenicity against Wild-Type and Mutant Virus and COVID-19 Infection among BNT162b2 Recipients. Vaccines (Basel) 2023; 11:497. [PMID: 36992081 PMCID: PMC10054100 DOI: 10.3390/vaccines11030497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND We aimed to investigate the effect of non-alcoholic fatty liver disease (NAFLD) on BNT162b2 immunogenicity against wild-type SARS-CoV-2 and variants and infection outcome, as data are lacking. METHODS Recipients of two doses of BNT162b2 were prospectively recruited. Outcomes of interest were seroconversion of neutralizing antibody by live virus microneutralization (vMN) to SARS-CoV-2 strains (wild-type, delta and omicron variants) at day 21, 56 and 180 after first dose. Exposure of interest was moderate-to-severe NAFLD (controlled attenuation parameter ≥ 268 dB/M on transient elastography). We calculated adjusted odds ratio (aOR) of infection with NAFLD by adjusting for age, sex, overweight/obesity, diabetes and antibiotic use. RESULTS Of 259 BNT162b2 recipients (90 (34.7%) male; median age: 50.8 years (IQR: 43.6-57.8)), 68 (26.3%) had NAFLD. For wild type, there was no difference in seroconversion rate between NAFLD and control groups at day 21 (72.1% vs. 77.0%; p = 0.42), day 56 (100% vs. 100%) and day 180 (100% and 97.2%; p = 0.22), respectively. For the delta variant, there was no difference also at day 21 (25.0% vs. 29.5%; p = 0.70), day 56 (100% vs. 98.4%; p = 0.57) and day 180 (89.5% vs. 93.3%; p = 0.58), respectively. For the omicron variant, none achieved seroconversion at day 21 and 180. At day 56, there was no difference in seroconversion rate (15.0% vs. 18.0%; p = 0.76). NAFLD was not an independent risk factor of infection (aOR: 1.50; 95% CI: 0.68-3.24). CONCLUSIONS NAFLD patients receiving two doses of BNT162b2 had good immunogenicity to wild-type SARS-CoV-2 and the delta variant but not the omicron variant, and they were not at higher risk of infection compared with controls.
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Affiliation(s)
- Ka Shing Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Department of Medicine, The University of Hong Kong, Shenzhen Hospital, Shenzhen 518009, China
| | - Lok Ka Lam
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Xianhua Mao
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Jing Tong Tan
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Poh Hwa Ooi
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ruiqi Zhang
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwok Hung Chan
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ivan F. N. Hung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai Kay Seto
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Department of Medicine, The University of Hong Kong, Shenzhen Hospital, Shenzhen 518009, China
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Man Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
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4
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Singh A, De A, Singh MP, Rathi S, Verma N, Premkumar M, Taneja S, Duseja A, Singh V. Antibody Response and Safety of ChAdOx1-nCOV (Covishield) in Patients with Cirrhosis: A Cross-Sectional, Observational Study. Dig Dis Sci 2023; 68:676-684. [PMID: 36156752 PMCID: PMC9510448 DOI: 10.1007/s10620-022-07641-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Patients with cirrhosis have a higher risk of severe COVID-19 and mortality and are high-priority patients for vaccination. However, cirrhotics were excluded from the phase 2/3 vaccine trials. Hence, we aimed to assess the antibody response and safety of Covishield (ChAdOx1nCoV-19) among patients with cirrhosis. METHODS Patients who attended the tele-hepatology services at our institute from March 2020 to June 2021 and diagnosed with cirrhosis as per their medical records were telephonically interviewed in July 2021 using a pre-specified questionnaire. Patients who had completed 2 doses of ChAdOx1-nCOV (with the 2nd dose administered at least 2 weeks back) and without history of documented COVID-19 infection (pre- or post-vaccination) were tested for antibodies against the spike protein. Seropositive patients were divided into high, moderate, and low antibody responses based on the signal/cut-off. RESULTS We interviewed 784 patients with cirrhosis. At least 1 dose of ChAdOx1-nCOV was received by 231 patients among whom 134 (58%) had received 2 doses. Documented COVID-19 was reported in 3.9% patients who received at least 1 dose of ChAdOx1-nCOV including breakthrough infections in 3.7% patients vaccinated with 2 doses. Local and systemic adverse events were reported by 42% and 22.1% patients. None developed anaphylaxis, acute decompensation, acute-on-chronic liver failure, or other serious adverse events requiring hospitalization. Seroconversion was documented in 81 (92%) out of 88 patients. No difference was observed in level of antibody response between patients with compensated and decompensated cirrhosis (p = 0.12). CONCLUSION Our preliminary data suggest that ChAdOx1-nCOV is safe with high seroconversion rates in patients with cirrhosis.
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Affiliation(s)
- Amandeep Singh
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.
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Ali FEM, Abd El-Aziz MK, Ali MM, Ghogar OM, Bakr AG. COVID-19 and hepatic injury: cellular and molecular mechanisms in diverse liver cells. World J Gastroenterol 2023; 29:425-449. [PMID: 36688024 PMCID: PMC9850933 DOI: 10.3748/wjg.v29.i3.425] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) represents a global health and economic challenge. Hepatic injuries have been approved to be associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The viral tropism pattern of SARS-CoV-2 can induce hepatic injuries either by itself or by worsening the conditions of patients with hepatic diseases. Besides, other factors have been reported to play a crucial role in the pathological forms of hepatic injuries induced by SARS-CoV-2, including cytokine storm, hypoxia, endothelial cells, and even some treatments for COVID-19. On the other hand, several groups of people could be at risk of hepatic COVID-19 complications, such as pregnant women and neonates. The present review outlines and discusses the interplay between SARS-CoV-2 infection and hepatic injury, hepatic illness comorbidity, and risk factors. Besides, it is focused on the vaccination process and the role of developed vaccines in preventing hepatic injuries due to SARS-CoV-2 infection.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | | | - Mahmoud M Ali
- Department of Pharmacology, Al-Azhar University, Assiut 71524, Egypt
| | - Osama M Ghogar
- Department of Biochemistry Faculty of Pharmacy, Badr University in Assiut, Egypt
| | - Adel G Bakr
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
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Papagiouvanni I, Kotoulas SC, Pataka A, Spyratos DG, Porpodis K, Boutou AK, Papagiouvannis G, Grigoriou I, Vettas C, Goulis I. COVID-19 and liver injury: An ongoing challenge. World J Gastroenterol 2023; 29:257-271. [PMID: 36687117 PMCID: PMC9846934 DOI: 10.3748/wjg.v29.i2.257] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in December 2019, in Wuhan, China. The virus was rapidly spread worldwide, causing coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is presented, usually, with typical respiratory symptoms (i.e., dyspnea, cough) and fever, extrapulmonary manifestations are also encountered. Liver injury is a common feature in patients with COVID-19 and ranges from mild and temporary elevation of liver enzymes to severe liver injury and, even, acute liver failure. The pathogenesis of liver damage is not clearly defined; multiple mechanisms contribute to liver disorder, including direct cytopathic viral effect, cytokine storm and immune-mediated hepatitis, hypoxic injury, and drug-induced liver toxicity. Patients with underlying chronic liver disease (i.e., cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID-19 and further liver deterioration, and, as a consequence, certain issues should be considered during disease management. The aim of this review is to present the prevalence, clinical manifestation and pathophysiological mechanisms of liver injury in patients with SARS-CoV-2 infection. Moreover, we overview the association between chronic liver disease and SARS-CoV-2 infection and we briefly discuss the management of liver injury during COVID-19.
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Affiliation(s)
- Ioanna Papagiouvanni
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Thessaloniki, Greece
| | | | - Athanasia Pataka
- Department of Respiratory Medicine, G Papanikolaou Hospital, Resp Failure Unit, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Dionisios G Spyratos
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Afroditi K Boutou
- Pulmonary Department, G Papanikolaou Hospital, Resp Failure Unit, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Georgios Papagiouvannis
- Department of Pharmacy, School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Ioanna Grigoriou
- Respiratory Failure Clinic, Papanikolaou General Hospital, Thessloniki 57001, Greece
| | - Christos Vettas
- Fourth Department of Internal Medicine, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokration General Hospital, Thessaloniki 54642, Greece
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7
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Beran A, Mhanna A, Mhanna M, Hassouneh R, Abuhelwa Z, Mohamed MFH, Sayeh W, Musallam R, Assaly R, Abdeljawad K. Real-world effectiveness of COVID-19 vaccination in liver cirrhosis: a systematic review with meta-analysis of 51,834 patients. Proc AMIA Symp 2023; 36:151-156. [PMID: 36876272 PMCID: PMC9980592 DOI: 10.1080/08998280.2023.2165344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
SARS-CoV-2 vaccinations were found to be highly effective in phase 3 clinical trials. However, these trials have not reported data regarding the subgroup of liver disease or excluded patients with liver disease. The effectiveness of COVID-19 vaccines among liver cirrhosis (LC) patients is unclear. We conducted this meta-analysis to assess the effectiveness of SARS-CoV-2 vaccination in LC patients. A comprehensive literature search was conducted to include all the relevant studies that compared the outcomes of LC patients who received SARS-CoV-2 vaccines vs. unvaccinated patients. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated by the Mantel-Haenszel method within a random-effect model. Four studies with 51,834 LC patients (20,689 patients received at least one dose vs 31,145 were unvaccinated) were included. COVID-19-related complications, including hospitalization (RR 0.73, 95% CI 0.59-0.91, P = 0.004), mortality (RR 0.29, 95% CI 0.16-0.55, P = 0.0001), and need for invasive mechanical ventilation (RR 0.29, 95% CI 0.11-0.77, P = 0.01), were significantly lower in the vaccinated group compared to the unvaccinated group. SARS-CoV-2 vaccination in LC patients reduced COVID-19-related mortality, intubation, and hospitalization. SARS-CoV-2 vaccination is highly effective in LC. Further prospective studies, preferably randomized controlled trials, are necessary to validate our findings and determine which vaccine is superior in patients with LC.
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Affiliation(s)
- Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Asmaa Mhanna
- Department of Pediatrics, ProMedica Hospital, Toledo, Ohio
| | | | - Ramzi Hassouneh
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Ziad Abuhelwa
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Mouhand F H Mohamed
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Wasef Sayeh
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Rami Musallam
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Khaled Abdeljawad
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
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8
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Schinas G, Polyzou E, Mitropetrou F, Pazionis A, Gogos C, Triantos C, Akinosoglou K. COVID-19 Vaccination in Patients with Chronic Liver Disease. Viruses 2022; 14:v14122778. [PMID: 36560782 PMCID: PMC9785164 DOI: 10.3390/v14122778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Vaccination against SARS-CoV-2 has become a central public health issue, primarily for vulnerable populations such as individuals with Chronic Liver Disease (CLD). Increased COVID-19-related mortality and disease severity has been noted in this subgroup of patients. Severe COVID-19 tends to further deregulate liver function in patients with chronic liver failure or cirrhosis and even reactivate hepatitis in people living with HBV or HCV. In addition, impaired hepatic function leads to several limitations in possible therapeutic interventions. Chronic hepatic dysregulation, along with the underlying cirrhosis-associated immune dysfunction (CAID), leads to a decreased immune response to vaccination that, in turn, may result in reduced efficacy rates and lowered lasting protection. According to current guidelines, timely vaccination and frequent booster shot administration are deemed necessary in this context. Vaccination-related adverse events are mostly mild in nature and similar to those reported in the general population, whereas the incidence of liver injury following vaccination is relatively rare. We aimed to review available evidence and recommendations associated with COVID-19 vaccination in patients with chronic liver disease, and provide insight to current issues and future directions.
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Affiliation(s)
- Georgios Schinas
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Eleni Polyzou
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
| | | | | | - Charalambos Gogos
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Christos Triantos
- Department of Medicine, University of Patras, 26504 Rio, Greece
- Division of Gastroenterology, Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Correspondence: or ; Tel.: +30-6972894651
| | - Karolina Akinosoglou
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
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9
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Lv L, Lin XQ, Chen Y, Chen HD, Zhang MX, Shao H, Tung TH, Zhu JS. Adverse reactions to inactivated COVID-19 vaccination in patients with chronic liver disease: The effect of anxiety. Hum Vaccin Immunother 2022; 18:2136435. [PMID: 36287551 PMCID: PMC9746530 DOI: 10.1080/21645515.2022.2136435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 01/14/2023] Open
Abstract
Studies have shown that patients with chronic liver disease are at a higher risk of contracting novel coronavirus pneumonia than healthy individuals, and many guidelines state that patients with chronic liver disease should be prioritized for COVID-19 vaccination, but there are a few studies on its safety in CLD patients. We aimed to evaluate the safety of the inactivated COVID-19 vaccine in patients with chronic liver disease, and the effect of anxiety on adverse reactions. A questionnaire survey for self-administered post-vaccination adverse reaction monitoring was conducted from June 17, 2021, to August 11, 2021, in patients with chronic liver disease attending a tertiary care hospital in Taizhou, China. We analyzed the data from of a total of 160 participants who scanned the QR code on social media to respond to the questionnaire. The overall incidence of adverse reactions after COVID-19 vaccination in patients with chronic liver disease was 44.4% (71/160), and the most common adverse reaction was local injection site reaction, accounting for 80.3% of adverse reactions (57/71). No serious adverse reactions were reported. Approximately 53.1% of the patients had anxiety about vaccination, and 51.8% of those who felt anxious reported adverse reactions. The safety of COVID-19 vaccination in patients with chronic liver disease is good, and there is a strong association between adverse reactions and vaccine anxiety. Pre-vaccination education for patients with vaccine anxiety and psychological counseling may reduce reports of adverse reactions and improve patients' confidence in the vaccine.
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Affiliation(s)
- Li Lv
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
| | - Xiao-Qing Lin
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - He-Dan Chen
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
| | - Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Hui Shao
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jian-Sheng Zhu
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
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Goel A, Verma A, Tiwari P, Katiyar H, Aggarwal A, Khetan D, Mayank, Kishore RVK, Kumar P, Singh TP, Sheikh S, Vaishnav M, Pathak P, Shalimar. Serological Immune Response Following ChAdOx1 nCoV-19 Vaccine (Covishield ®) in Patients with Liver Cirrhosis. Vaccines (Basel) 2022; 10:1837. [PMID: 36366346 PMCID: PMC9696004 DOI: 10.3390/vaccines10111837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Data are limited on antibody response to the ChAdOx1 nCoV-19 vaccine (AZD1222; Covishield®) in cirrhosis. We studied the antibody response following two doses of the ChAdOx1 vaccine, given 4−12 weeks apart, in cirrhosis. Methods: Prospectively enrolled, 131 participants (71% males; age 50 (43−58); alcohol-related etiology 14, hepatitis B 33, hepatitis C 46, cryptogenic 21, autoimmune 9, others 8; Child−Turcott−Pugh class A/B/C 52/63/16). According to dose intervals, the participants were grouped as ≤6 weeks (group I), 7−12 weeks (group II), and 13−36 weeks (group III). Blood specimens collected at ≥4 weeks after the second dose were tested for anti-spike antibody titre (ASAb; positive ≥ 0.80 U/mL) and neutralizing antibody (NAb; positive ≥20% neutralization) using Elecsys Anti-SARS-CoV-2 S (Roche) and SARS-CoV-2 NAb ELISA Kit (Invitrogen), respectively. Data are expressed as number (proportion) and median (interquartile range) and compared using non-parametric tests. Results: Overall, 99.2% and 84% patients developed ASAb (titre 5440 (1719−9980 U/mL)) and NAb (92 (49.1−97.6%)), respectively. When comparing between the study groups, the ASAb titres were significantly higher in group II than in group I (2613 (310−7518) versus 6365 (2968−9463), p = 0.027) but were comparable between group II and III (6365 (2968−9463) versus 5267 (1739−11,653), p = 0.999). Similarly, NAb was higher in group II than in group I (95.5 (57.6−98.0) versus 45.9 (15.4−92.0); p < 0.001), but not between the groups II and III (95.5 (57.6−98.0) versus 92.4 (73.8−97.5); p = 0.386). Conclusion: Covishield® induces high titres of ASAb and NAb in cirrhosis. A higher titre is achieved if two doses are given at an interval of more than six weeks.
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Affiliation(s)
- Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Alka Verma
- Department of Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Prachi Tiwari
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Harshita Katiyar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Dheeraj Khetan
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Mayank
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ravi V. Krishna Kishore
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Pankaj Kumar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Thakur Prashant Singh
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sabreena Sheikh
- Department of Gastroenterology and Human Nutrition Unit, All Indian Institute of Medical Sciences, New Delhi 110029, India
| | - Manas Vaishnav
- Department of Gastroenterology and Human Nutrition Unit, All Indian Institute of Medical Sciences, New Delhi 110029, India
| | - Piyush Pathak
- Department of Gastroenterology and Human Nutrition Unit, All Indian Institute of Medical Sciences, New Delhi 110029, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All Indian Institute of Medical Sciences, New Delhi 110029, India
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11
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Wang Y, Wu G, Jiang Y, Zou F, Gan L, Luo Q, Wu X, Tang X. Does COVID-19 have an impact on influenza vaccine knowledge, attitude and practice among medical students: a 2-year prospective cohort study. BMJ Open 2022; 12:e055945. [PMID: 36109037 PMCID: PMC9478856 DOI: 10.1136/bmjopen-2021-055945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the main factors affecting the knowledge, attitude and practice about influenza and influenza vaccine as well as the intention to receive influenza vaccination among the same group of medical students before (2019) and after (2021) the COVID-19 outbreak. DESIGN A population-based prospective cohort study. SETTING A longitudinal cohort study of a selected medical school in Chongqing, China, which ran from 2019 to 2021. PARTICIPANTS A total of 803 medical students participated in the study in 2019 and only 484 students responded in 2021. The response rate for our survey was only 60.27% due to graduation, emails being abandoned, etc. RESULTS: The influenza vaccination rate of students at this medical school was 6.7% in 2019, compared with 25.8% in 2021. The awareness rate of medical students about influenza and influenza vaccine was 82.8% in 2019 and 86% in 2021, and there was no significantly statistical difference between the 2 years (p=0.134); the number of medical students with supportive attitude towards influenza vaccine was 95.1% in 2019 and 97.1% in 2021, and there was no statistically significant difference between the 2 years (p=0.078); the number of students who actively learnt about knowledge related to influenza vaccine rose from 183 (22.8%) in 2019 to 195 (40.3%) in 2021. CONCLUSIONS The COVID-19 outbreak prompted an increase in influenza vaccination rates among medical students in Chongqing, with almost all students (96.0%) believing that the spread of COVID-19 promoted their knowledge about influenza and influenza vaccine, and the vast majority (74.8%) believing that the spread of COVID-19 promoted their willingness to receive influenza vaccine.
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Affiliation(s)
- Yunlong Wang
- School of basic medicine, Chongqing Medical University, Chongqing, China
| | - Guangjie Wu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yueming Jiang
- Clinical 5+3 Integration, The Second Clinical School, Chongqing Medical University, Chongqing, China
| | - Fa Zou
- School of basic medicine, Chongqing Medical University, Chongqing, China
| | - Lin Gan
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qinwen Luo
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaorong Wu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaojun Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
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12
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Giambra V, Piazzolla AV, Cocomazzi G, Squillante MM, De Santis E, Totti B, Cavorsi C, Giuliani F, Serra N, Mangia A. Effectiveness of Booster Dose of Anti SARS-CoV-2 BNT162b2 in Cirrhosis: Longitudinal Evaluation of Humoral and Cellular Response. Vaccines (Basel) 2022; 10:vaccines10081281. [PMID: 36016169 PMCID: PMC9415026 DOI: 10.3390/vaccines10081281] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background: LC has been associated with hyporesponsiveness to several vaccines. Nonetheless, no data on complete serological and B- and T-cell immune response are currently available. Aims: To assess, in comparison with healthy controls of the same age and gender, both humoral and cellular immunoresponses of patients with LC after two or three doses of the mRNA Pfizer-BioNTech vaccine against SARS-CoV-2 and to investigate clinical features associated with non-response. Material and methods: 179 patients with LC of CTP class A in 93.3% and viral etiology in 70.1% of cases were longitudinally evaluated starting from the day before the first dose to 4 weeks after the booster dose. Their antibody responses were compared to those of healthcare workers without co-morbidities. In a subgroup of 40 patients, B- and T-cell responses were also compared to controls. Results: At d31, d90 and d180 after BNT162b2 vaccine, no detectable SARS-CoV-2 IgG response was observed in 5.9%, 3.9% and 7.2% of LC patients as compared to 0 controls (p < 0.03). A delay in B-cell and lack of prompt T-cell response compared to healthcare workers was also registered. A significant correlation between antibody titers and cellular response was observed. A MELD score > 8 was the only independent predictor of poor d31 response (p = 0.028). Conclusions: Our results suggest that cirrhotic patients have a slower and in <10% suboptimal immune response to SARS-CoV-2 vaccination. Rates of breakthrough infections were comparable between cirrhotics and controls. The booster dose was critical in inducing both humoral and cellular responses comparable to controls.
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Affiliation(s)
- Vincenzo Giambra
- Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Annarita Valeria Piazzolla
- Liver Unit, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Giovanna Cocomazzi
- Liver Unit, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Maria Maddalena Squillante
- Liver Unit, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Elisabetta De Santis
- Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Beatrice Totti
- Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Chiara Cavorsi
- Liver Unit, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Francesco Giuliani
- ICT Innovation and Research Unit, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Nicola Serra
- Department of Public Health, University “Federico II”, 80138 Napoli, Italy
| | - Alessandra Mangia
- Liver Unit, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
- Correspondence: ; Tel.: +39-882-416375
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13
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Guarino M, Cossiga V, Capasso M, Mazzarelli C, Pelizzaro F, Sacco R, Russo FP, Vitale A, Trevisani F, Cabibbo G. Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma. J Clin Med 2022; 11:4475. [PMID: 35956091 PMCID: PMC9369221 DOI: 10.3390/jcm11154475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023] Open
Abstract
Worldwide, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly increases mortality and morbidity. The Coronavirus Disease 2019 (COVID-19) outbreak has had a considerable impact on healthcare systems all around the world, having a significant effect on planned patient activity and established care pathways, in order to meet the difficult task of the global pandemic. Patients with hepatocellular carcinoma (HCC) are considered a particularly susceptible population and conceivably at increased risk for severe COVID-19 because of two combined risk factors: chronic advanced liver disease and HCC itself. In these challenging times, it is mandatory to reshape clinical practice in a prompt way to preserve the highest standards of patient care and safety. However, due to the stay-at-home measures instituted to stop the spread of COVID-19, HCC surveillance has incurred a dramatic drop, and care for HCC patients has been rearranged by refining the algorithm for HCC treatment to the COVID-19 pandemic, permitting these patients to be safely managed by identifying those most at risk of neoplastic disease progression.
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Affiliation(s)
- Maria Guarino
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Valentina Cossiga
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Mario Capasso
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.P.); (F.P.R.)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Policlinico Riuniti, 71122 Foggia, Italy;
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.P.); (F.P.R.)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy;
| | - Franco Trevisani
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE)-University of Palermo, 90133 Palermo, Italy;
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14
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Salgüero Fernández S, Gabriel Medina P, Almería Lafuente A, Ballesteros Vizoso MA, Zamora Trillo A, Casals Mercadal G, Solé Enrech G, Lalana Garcés M, Guerra Ruiz AR, Ortiz Pastor O, Morales Ruiz M. Infección por SARS-CoV-2 y su impacto en la enfermedad hepática. ADVANCES IN LABORATORY MEDICINE 2022; 3:134-141. [PMCID: PMC10197296 DOI: 10.1515/almed-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023]
Abstract
Introducción En el contexto de la infección por SARS-CoV-2 no es infrecuente encontrar alteraciones hepáticas, tanto en pacientes con enfermedad hepática crónica previa como sin ella. Contenido En esta revisión, se examina el conocimiento actual sobre la relación entre la COVID-19 y el daño hepático, frecuentemente observado en el seno de esta enfermedad. Resumen Si bien no está completamente dilucidada la patogénesis del daño hepático, parece ser consecuencia de la combinación de varios factores, entre los que se encuentran el daño directo del virus, el derivado de la hiperactivación del sistema inmune, el isquémico y el farmacológico. El valor pronóstico de estas alteraciones también está bajo intensa investigación. La potencial repercusión de las mismas aboga por la necesidad de adecuar el manejo y el tratamiento de los pacientes, particularmente en el contexto de pacientes con enfermedad hepática crónica o trasplantados hepáticos. Perspectiva Se desconocen actualmente muchos aspectos relativos a la afectación hepática durante la COVID-19, particularmente en las formas graves de la enfermedad. El desarrollo de nuevos estudios referidos a las implicaciones clínicas de la COVID-19 en el hígado, tanto en estado sano como enfermo, podrían ayudar a ajustar las recomendaciones de tratamiento y vacunación según el perfil del paciente.
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Affiliation(s)
- Sergio Salgüero Fernández
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitario Fundación Alcorcón, Madrid, Zaragoza, España
| | - Pablo Gabriel Medina
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Bioquímica, Hospital Universitari Vall d’Hebron, Barcelona, Zaragoza, España
| | - Alejandro Almería Lafuente
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Bioquímica Clínica, Hospital Royo Villanova, Zaragoza, España
| | - María Antonieta Ballesteros Vizoso
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases. Palma de Mallorca, Zaragoza, España
| | - Angielys Zamora Trillo
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Bioquímica Clínica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gregori Casals Mercadal
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Bioquímica y Genética Molecular, CDB, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Gemma Solé Enrech
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Laboratorio, UDIAT-CD. Corporació Sanitaria Parc Taulí, Sabadell, España
| | - Marta Lalana Garcés
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital de Barbastro, Huesca, España
| | - Armando R. Guerra Ruiz
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Oihana Ortiz Pastor
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Bioquímica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Manuel Morales Ruiz
- Comisión de valoración bioquímica de la enfermedad hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
- Servicio de Bioquímica y Genética Molecular, CDB, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Departamento de Biomedicina de la Facultad de Medicina y Ciencias de la Salud-Universidad de Barcelona, Barcelona, España
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15
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Salgüero Fernández S, Gabriel Medina P, Almería Lafuente A, Ballesteros Vizoso MA, Zamora Trillo A, Casals Mercadal G, Solé Enrech G, Lalana Garcés M, Guerra Ruiz AR, Ortiz Pastor O, Morales Ruiz M. Impact of SARS-CoV-2 infection on liver disease. ADVANCES IN LABORATORY MEDICINE 2022; 3:126-141. [PMID: 37361869 PMCID: PMC10197317 DOI: 10.1515/almed-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Abnormal liver biochemistry is not a rare finding in the context of SARS-CoV-2 infection, regardless of patients having pre-existing chronic disease or not. CONTENT This review examines the current body of knowledge on the relationship between COVID-19 and liver injury, which is frequently found in this setting. SUMMARY Although the pathogenesis of liver injury is not fully understood, it has been suggested to be the result of a combination of multiple factors. These include direct injury caused by the virus, immune system hyperactivation, ischemic and drug-induced injury. The prognostic valor of these alterations is also the subject of intense research. Due to their potential impact, these alterations require proper management and treatment, especially in patients with chronic liver disease or liver transplant recipients. OUTLOOK Some aspects associated with liver injury during COVID-19, especially in severe presentations, are not well understood. Studies assessing the clinical impact of COVID-19 on the healthy or diseased liver may help adjust treatment and immunization guidelines to the profile of the patient.
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Affiliation(s)
- Sergio Salgüero Fernández
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Service of Clinical Analysis, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Pablo Gabriel Medina
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Department of Clinical Biochemistry, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Alejandro Almería Lafuente
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Department of Clinical Biochemistry, Hospital Royo Villanova, Zaragoza, Spain
| | - María Antonieta Ballesteros Vizoso
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Service of Clinical Analysis, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Angielys Zamora Trillo
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Department of Clinical Biochemistry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gregori Casals Mercadal
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Service of Biochemistry and Molecular Genetics, CDB, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - Gemma Solé Enrech
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Laboratory Service UDIAT-CD, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Marta Lalana Garcés
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Service of Clinical Analysis, Hospital de Barbastro, Huesca, Spain
| | - Armando R. Guerra Ruiz
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Service of Clinical Analysis, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Oihana Ortiz Pastor
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manuel Morales Ruiz
- Biochemistry of Liver Disease Commision–Spanish Society of Laboratory Medicine (SEQC-ML), Alcorcon, Spain
- Service of Biochemistry and Molecular Genetics, Department of Biomedicine of the Faculty of Medicine and Health Sciences, Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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Cheung KS, Lam LK, Hui RWH, Mao X, Zhang RR, Chan KH, Hung IF, Seto WK, Yuen MF. Effect of moderate-to-severe hepatic steatosis on neutralising antibody response among BNT162b2 and CoronaVac recipients. Clin Mol Hepatol 2022; 28:553-564. [PMID: 35545127 PMCID: PMC9293606 DOI: 10.3350/cmh.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 11/05/2022] Open
Abstract
Aim Studies of hepatic steatosis (HS) effect on COVID-19 vaccine immunogenicity are lacking. We aimed to compare immunogenicity of BNT162b2 and CoronaVac among moderate/severe HS and control subjects. Patients and Methods 295 subjects who received BNT162b2 or CoronaVac vaccines from five vaccination centers were categorized into moderate/severe HS (controlled attenuation parameter ≥268 dB/m on transient elastography) (n=74) or control (n=221) groups. Primary outcomes were seroconversion rates of neutralising antibody by live virus Microneutralization (vMN) assay (titer ≥10) at day 21 (BNT162b2) or day28 (CoronaVac) and day56 (both). Secondary outcome was highest-tier titer response (top 25% of vMN titer; cutoff: 160 [BNT162b2] and 20 [CoronaVac]) at day 56. Results For BNT162b2 (n=228 [77.3%]), there was no statistical differences in seroconversion rates (71.7% vs 76.6% [day21]; 100% vs 100% [day56]) or vMN GMT (13.2 vs 13.3, [day21]; 91.9 vs 101.4, [day56]) among moderate/severe HS and control groups respectively. However, lower proportion of moderate/severe HS patients had highest-tier response (5.0% vs 15.5%; p=0.037 [day56]). For CoronaVac (n=67 [22.7%]), there was no statistical differences in seroconversion rates (7.1% vs 15.1%, [day21]; 64.3% vs 83.0%, [day56]) or vMN GMT (5.3 vs 5.8,) at day 28. However, moderate/severe HS patients had lower vMN GMT (9.1 vs 14.8, p=0.021) at day 56 with lower proportion having highest-tier response (21.4% vs 52.8%, p=0.036). Conclusion While there was no difference in seroconversion rate between moderate/severe HS and control groups after two doses of vaccine, a lower proportion of moderate/severe HS patients achieved highest-tier response for either BNT162b2 or CoronaVac.
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Affiliation(s)
- Ka Shing Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lok Ka Lam
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Rex Wan Hin Hui
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Xianhua Mao
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ruiqi R Zhang
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwok Hung Chan
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ivan Fn Hung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai Kay Seto
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Man Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
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17
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Law MF, Ho R, Law KWT, Cheung CKM. Gastrointestinal and hepatic side effects of potential treatment for COVID-19 and vaccination in patients with chronic liver diseases. World J Hepatol 2021; 13:1850-1874. [PMID: 35069994 PMCID: PMC8727202 DOI: 10.4254/wjh.v13.i12.1850] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/20/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) is a global pandemic. Many clinical trials have been performed to investigate potential treatments or vaccines for this disease to reduce the high morbidity and mortality. The drugs of higher interest include umifenovir, bromhexine, remdesivir, lopinavir/ritonavir, steroid, tocilizumab, interferon alpha or beta, ribavirin, fivapiravir, nitazoxanide, ivermectin, molnupiravir, hydroxychloroquine/chloroquine alone or in combination with azithromycin, and baricitinib. Gastrointestinal (GI) symptoms and liver dysfunction are frequently seen in patients with COVID-19, which can make it difficult to differentiate disease manifestations from treatment adverse effects. GI symptoms of COVID-19 include anorexia, dyspepsia, nausea, vomiting, diarrhea and abdominal pain. Liver injury can be a result of systemic inflammation or cytokine storm, or due to the adverse drug effects in patients who have been receiving different treatments. Regular monitoring of liver function should be performed. COVID-19 vaccines have been rapidly developed with different technologies including mRNA, viral vectors, inactivated viruses, recombinant DNA, protein subunits and live attenuated viruses. Patients with chronic liver disease or inflammatory bowel disease and liver transplant recipients are encouraged to receive vaccination as the benefits outweigh the risks. Vaccination against COVID-19 is also recommended to family members and healthcare professionals caring for these patients to reduce exposure to the severe acute respiratory syndrome coronavirus 2 virus.
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Affiliation(s)
- Man Fai Law
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Rita Ho
- Department of Medicine, North District Hospital, Hong Kong, China
| | | | - Carmen Ka Man Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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18
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Łykowska-Szuber L, Wołodźko K, Rychter AM, Szymczak-Tomczak A, Krela-Kaźmierczak I, Dobrowolska A. Liver Injury in Patients with Coronavirus Disease 2019 (COVID-19)-A Narrative Review. J Clin Med 2021; 10:5048. [PMID: 34768568 PMCID: PMC8585115 DOI: 10.3390/jcm10215048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 02/06/2023] Open
Abstract
While respiratory symptoms are prevalent in SARS-CoV-2 infected patients, growing evidence indicates that COVID-19 affects a wide variety of organs. Coronaviruses affect not only the respiratory system, but also the circulatory, nervous and digestive systems. The most common comorbidities in COVID-19 patients are hypertension, followed by diabetes, cardiovascular, and respiratory disease. Most conditions predisposing to SARS-CoV-2 infection are closely related to the metabolic syndrome. Obesity and chronic diseases, including liver disease, are associated with the induction of pro-inflammatory conditions and a reduction in immune response disorders, leading to the suspicion that these conditions may increase the susceptibility to SARS-CoV2 infection and the risk of complications. The definition of liver damage caused by COVID-19 has not yet been established. COVID-19 may contribute to both primary and secondary liver injury in people with pre-existing chronic disease and impaired liver reserves, leading to exacerbation of underlying disease, liver decompensation, or acute chronic liver failure. Therefore, many researchers have interpreted it as clinical or laboratory abnormalities in the course of the disease and treatment in patients with or without pre-existing liver disease. The research results available so far indicate that patients with liver disease require special attention in the event of COVID-19 infection.
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Affiliation(s)
- Liliana Łykowska-Szuber
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland; (K.W.); (A.S.-T.); (I.K.-K.); (A.D.)
| | | | - Anna Maria Rychter
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland; (K.W.); (A.S.-T.); (I.K.-K.); (A.D.)
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