THE COURSE OF ALCOHOLIC LIVER DISEASE IN THE POST-COVID-19 PERIOD: OBSERVATIONAL STUDY USING TELEMEDICINE TECHNOLOGIES
Abstract
Introduction. Scientific research during the COVID-19 pandemic has been partially refocused on the use of telemedicine technologies (remote collection of information from patients). Previously, the direct cytotoxic effect of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) on cholangiocytes and hepatocytes was established, as a result of which patients with аlcoholic liver disease (ALD) are at increased risk of severe course and the development of an adverse outcome in COVID-19. Currently, data on long-term survival in ALD in the post-COVID-19 period are limited. Aim: To characterize the features of the course of CLD and to evaluate the 3-, 6-month and one-year survival after coronavirus infection in patients with ALD using telemedicine technologies. Materials and methods. The study included 108 patients with ALD who were treated at the V.M. Buyanov State Clinical Hospital. The main group included 54 seropositive IgG patients for SARS-CoV-2 for the period 20.12.2021 — 06.01.2022. The control group — 54 patients with ALD hospitalized in 2017. In the COVID (+) group analysis of symptoms over time and assessment of survival were carried out by telephone survey after 3, 6, 9 and 12 months after discharge. Results. In the COVID (+) group, compared with the control group, edematous-ascitic syndrome was significantly more common (74.1 and 55.6%, respectively, p = 0.044), portal vein thrombosis (PVT) (18.5% and 5.6%, p = 0.04. The survival time in the COVID (+) group was 4 months, and the average survival time of patients without a history of coronavirus infection was 8.09±0.68 months (Log-rank test: 2=5.92; df=1; p=0.015); one-year survival for the COVID group (+) — 33,3 % (36/54), COVID (–) — 57.4% (23/54) (OR 1.95; 95% CI 1.14 — 3.34). Conclusion. Telemedicine expands the possibilities of long-term remote monitoring of patients in order to assess the dynamics of symptoms and outcomes. Patients who had a coronavirus infection were characterized by a higher mortality rate after a year of follow-up. In the clinical picture of patients with ALD in the post-COVID-19 period, edematous-ascitic syndrome prevailed, and the frequency of PVT significantly increased.
References
Ильченко Л.Ю., Никитин И.Г., Федоров И.Г. COVID-19 и поражение печени. Архивъ внутренней медицины. 2020; 3(10): 188–97. DOI: 10.20514/2226-6704-2020-10-3-188-197.
Кобякова О.С., Стародубов В.И., Кадыров Ф.Н. Телемедицинские технологии: перспективы и ограничения. Врач и информационные технологии. 2020; 5: 76–85. DOI: 10.37690/1811-0193-2020-5-76-85.
Медведева Е.И., Александрова О.А., Крошилин С.В. Телемедицина в современных условиях: отношение социума и вектор развития. Экономические и социальные перемены: факты, тенденции, прогноз. 2022; 15(3): 200–22. DOI: 10.15838/esc.2022.3.81.11.
Bouabida K., Lebouché B., Pomey M.P. Telehealth and COVID-19 Pandemic: An Overview of the Telehealth Use, Advantages, Challenges, and Opportunities during COVID-19 Pandemic. Healthcare (Basel). 2022; 10(11): 2293. DOI: 10.3390/healthcare10112293.
Gates B. Colbert, A. Verner Venegas-Vera, Edgar V. Lerma. Utility of telemedicine in the COVID-19 era. Rev. Cardiovasc. Med. 2020; 21(4): 583–7. DOI: 10.31083/j.rcm.2020.04.188.
Ge J., Digitale J.C., Pletcher M.J. et al. N3C Consortium. Breakthrough SARS-CoV-2 Infection Outcomes in Vaccinated Patients with Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study. Preprint. MedRxiv. 2022. DOI: 10.1101/2022.02.25.22271490.
Iavarone M., D’Ambrosio R., Soria A. et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol. 2020; 73(5): 1063–71. DOI: 10.1016/j.jhep.2020.06.001.
Kunutsor S., Laukkanen J. Incidence of venous and arterial thromboembolic complications in COVID-19: a systematic review and meta-analysis. Thromb Res. 2020; 196: 27–30. DOI: 10.1016/j.thromres.2020.08.022.
Marjot T., Moon A., Cook J. et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2021; 3(74): 567–77. DOI: 1 0.1016/j.jhep.2020.09.024.
Nagarajan R., Krishnamoorthy Y., Rajaa S., Hariharan V.S. COVID-19 Severity and Mortality Among Chronic Liver Disease Patients: A Systematic Review and Meta-Analysis. Prev Chronic Dis. 2022; 19: E53. DOI: 10.5888/pcd19.210228.
Northup P., Garcia-Pagan J., Garcia-Tsao G. et al. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021; 1(73): 366–413. DOI: 10.1002/hep.31646.
Rajan S., Khunti K., Alwan N. et al. In the wake of the pandemic: Preparing for Long COVID. Copenhagen (Denmark): European Observatory on Health Systems and Policies. 2021. https://www.ncbi.nlm.nih.gov/books/NBK569598/pdf/Bookshelf_NBK569598.pdf.
Sarin S.K., Choudhury A., Lau G.K. et al. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int. 2020; 14(5): 690–700. DOI: 10.1007/s12072-020-10072-8.
Szabo G., Saha B. Alcohol’s Effect on Host Defense. Alcohol Res. 2015; 2(37): 159–70.
Turon F., Driever E., Baiges A. et al. Predicting portal thrombosis in cirrhosis: A prospective study of clinical, ultrasonographic and hemostatic factors, J Hepatology. 2021; 6(75): 1367–76. DOI: 10.1016/ j.jhep.2021.07.020.
Valdes D., Alqazlan L., Procter R., Dale J. Global evidence on the rapid adoption of telemedicine in primary care during the first 2 years of the COVID-19 pandemic: a scoping review protocol. Syst Rev. 2022; 11(1): 124. DOI: 10.1186/s13643-022-01934-3.
Wijesooriya N.R., Mishra V., Brand P.L., Rubin B.K. COVID-19 and telehealth, education, and research adaptations. Paediatr Respir Rev. 2020; 35: 38–42. DOI: 10.1016/j.prrv.2020.06.009.
World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. World Health Organization. https://iris.who.int/bitstream/handle/10665/44497/9789241564144_eng.pdf.
Xiao Y., Wu D., Shi X. et al. High Child-Pugh and CRUB65 scores predict mortality of decompensated cirrhosis patients with COVID-19: A 23-center, retrospective study. Virulence. 2021; 12(1): 1199–1208. DOI: 10.1080/21505594.2021.1909894.
Zanetto A., Pelizzaro F., Campello E. et al. Severity of systemic inflammation is the main predictor of ACLF and bleeding in individuals with acutely decompensated cirrhosis. Journal of Hepatology. 2023; 78(2): 301–11. DOI: 10.1016/j.jhep.2022.09.005.
