key: cord-0813779-r3y065re authors: Liu, Furong; Long, Xin; Ji, Guibao; Zhang, Bixiang; Zhang, Wanguang; Zhang, Zhanguo; Chen, Xiaoping title: Clinically significant portal hypertension in cirrhosis patients with COVID-19: Clinical characteristics and outcomes date: 2020-06-17 journal: J Infect DOI: 10.1016/j.jinf.2020.06.029 sha: 666e11fee641a31c272b181ca0183e1b8b96deff doc_id: 813779 cord_uid: r3y065re nan . Typical pulmonary CT and hepatic ultrasound in patients with CSPH and non-CSPH patients. CSPH, Clinically significant portal hypertension. lower lymphocyte, platelet and hemoglobin, higher total bilirubin, longer prothrombin time and activated partial thromboplastin time (Wilcoxon signed rank test, P < 0.05). During the course of COVID-19, the most frequent complications were abnormal liver function (64.7%), kidney injury (47.1%), and ARDS (29.4%), and all CSPH patients showed abnormal liver function. Notably, one CSPH patient developed esophageal gastric variceal bleeding (EGVB), which is one of the most serious complications. In addition, 66.7% (4/6) of CSPH patients were severe cases, compared with 18.2% (2/11) of non-CSPH patients ( P = 0.025). In the course of treatment, antiviral (88.2%), antimicrobial (76.5%), hepatoprotective (64.7%) and oxygen (35.3%) therapy were the most commonly used, and CSPH patients had a higher proportion of hepatoprotective therapy (6/6 vs 5/11, P = 0.025) and oxygen therapy (4/6 vs 2/11, P = 0.046) than non-CSPH patients. Also, the endoscopic sclerotherapy was applied to deal with EGVB. In addition, 3 patients (17.6%) were admitted to the intensive care unit (ICU), and died. Many researches have shown that the liver is a target organ for SARS-CoV-2, and some patients with COVID-19 suffered from https://doi.org/10.1016/j.jinf.2020.06.029 0163-4453/© 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved. liver injury, although this may not lead to serious clinical consequences 6 . However, for patients with pre-existing liver disease, there may be a greater risk after SARS-CoV-2 infection. For example, Ji et al. reported that non-alcoholic fatty liver disease (NAFLD) patients with COVID-19 had a higher rate of disease progression 7 . Cirrhosis patients tend to be at high risk of COVID-19 due to their specific characteristics 8 . On the blood test findings, many indicators were abnormal, which may be caused by the characteristics of cirrhosis, and these may be markers of the severity of COVID-19, such as decreased platelets and lymphocytes 9 , 10 , which were more obvious in CSPH patients. Consistent with these findings, 35.3% of COVID-19 patients with cirrhosis in our study were severe illness, and the proportion of CSPH patients was 64.7%, suggesting that cirrhosis, especially CSPH, may play an important role in the progression of COVID-19. However, it is encouraging to note that the mortality of in this study was not high, possibly because our center has rich experience in the treatment of cirrhosis and CSPH, as well as in the treatment of other organs in conjunction with the multidisciplinary team. When treating COVID 19 patients with cirrhosis, other complications such as EGVB, heart damage, and kidney damage should also be noted in the control of pulmonary symptoms. However, only 17 cirrhosis patients with COVID-19 were included in this study, due to the low overall incidence of cirrhosis patients. More cases and comparative studies should be analyzed for more robust results. Nonetheless, our results suggest that cirrhosis, especially CSPH, may aggravate the severity of COVID-19. The authors disclose no conflicts. XC and ZZ conceived this study. XL, GJ, ZZ, BZ and WZ treated the patients. ZZ and FL made a statistical analysis and wrote the manuscript. Markers of liver injury and clinical outcomes in COVID-19 patients: a systematic review and meta-analysis Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases Liver impairment in COVID-19 patients: a retrospective analysis of 115 cases from a single center in Wuhan city Implication of non-alcoholic fatty liver diseases (NAFLD) in patients with COVID-19: a preliminary analysis The intestinal flora and bacterial infection in cirrhosis Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study This retrospective study was authorized by the Ethic Committee of Wuhan Tongji Hospital. This study was funded by the State Key Project on Infection Disease of China (No. 2018ZX10723204-003).