COVID19-FOIE National Observatory
Condition: Liver Diseases; COVID19
MeSH terms: COVID-19; Liver Diseases
Study type: Observational

Summary: 
      Background:

      The COVID19 and liver relationships are very rare. The preliminary Chinese data indicate that
      2-11% of patients treated for COVID19 had an underlying chronic liver disease. However, there
      is no clinical data on morbi-mortality in this context.

      Objectives:

      Primary Objective:

      Evaluate the mortality related to Covid-19 in patients with a chronic liver disease

      Secondary objectives:

        -  Evaluate the mortality (liver-related and no liver-related) due to the Covid-19
           according to the cirrhotic status, an history of hepatocellular carcinoma, an
           immunosuppressive treatment and its type, the etiology-ies of liver disease at the
           diagnosis of Covid-19 (viral hepatitis -B and/or C-, liver disease related to alcohol
           consumption, metabolic syndrome, hemochromatosis, immune liver disease, other or
           unknown), and comorbidities

        -  Evaluate the liver morbidity related to Covid-19, including

        -  incidence of liver biochemical abnormalities in patients with normal liver enzymes
           values or of a 2-fold increase of usual values for AST, ALT, GGT, Alcalines Phosphatasis

        -  incidence of liver complications (acute hepatitis, liver insufficiency, decompensation
           of cirrhosis, encephalopathy, renal insufficiency)

      Patients:

      All patients with a liver disease (chronic or acute) with a positive diagnosis of Covid-19
      assessed either by positive PCR or specific thoracic abnormalities at TDM

      Methodology:

      Observational ambispective study consisting exclusively of a collection of data from patients
      with liver diseases and managed for COVID 19 The data is collected and transcribed on a
      secure electronic eCRF hosted at the Assitance Publique des Hôpitaux de Paris and accessible
      online from the AFEF website

      Duration and organisation of the research:

      After information of the patients and making available a non-opposition form, the main
      demographic and clinical data related to the liver disease and to the COVID19 already
      collected in the patient's medical record will be collected in a dedicated e-CRF.

      Effective of the study:

      All consecutive patients included in the study whose data are collected e-CRF until
      31/12/2020.
    

Detailed description: 
      1. Background and objectives:

           Coronavirus infection 2019 (COVID-19), linked to the SARS-Cov-2 virus, is rapidly
           spreading worldwide. After the city of Wuhan and the province of Hubei, European
           healthcare systems are facing an outbreak of seriously ill patients, but few are fully
           equipped to manage this health crisis.

           On the occasion of this pandemic, the hepatologist associations of United States ,
           Europe and France as well as the French Federation of Digestive Cancer have proposed
           modalities for the management of patients with chronic liver disease likely to guarantee
           them maximum safety. The level of scientific evidence for these proposals is very low,
           given the small amount of objective clinical data available to date on the relationship
           between COVID-19 and liver.

           Some preliminary Chinese data indicates that:

             -  2-11% of patients treated for COVID19 had underlying chronic liver disease

             -  an increase in transaminases is observed in 25-35% of patients, generally moderate
                (median 23-39 IU/L), with a higher rate in symptomatic and/or severe forms and/or
                requiring hospitalization in intensive care unit as well as in patients who later
                die . The mechanism involved is uncertain to date. Indeed, the data suggesting the
                possibility of localization of the virus in the liver are too preliminary, and it
                is reasonable to incriminate the elements of inflammatory reaction syndrome. Liver
                damage can be explained during these infections by hepatic hypoxia, related to a
                frequent viral myocarditis in this situation. Finally, other more classic causes
                may also be associated, including drug (paracetamol, antibiotics), or an
                exacerbation of an underlying chronic liver disease, known or unknown. Control of
                viral serologies B and C is therefore recommended in this situation.

             -  elderly patients, patients with cirrhosis, patients with immune hepatitis under
                immunosuppressive drugs and patients before and after transplantation under
                immunosuppressive therapy would be the subjects most at risk of severe COVID19

             -  very strict preventive measures have proven their effectiveness in terms of
                mortality in 111 patients with decompensated cirrhosis, including 2/3 hospitalized
                and 1/3 ambulatory.

           In this totally new and unexpected context, the board meeting of the AFEF proposes the
           national observatory COVID19-FOIE, intended to collect data of patients with liver
           disease (all stages combined) or liver transplants that developed COVID19 confirmed by
           PCR on nasopharyngeal sampling and/or thoracic CT.

        2. Population:

           All patients with acute or chronic liver disease treated by a member of the AFEF with an
           established diagnosis of COVID 19 confirmed by PCR on nasopharyngeal and/or thoracic CT.

        3. Methodology:

           This is an epidemiological, observational, prospective, descriptive, prognostic and
           evaluative observational cohort study. This study does not change the patient's
           management; it consists of analyzing clinical-biological data collected as part of the
           patient's usual follow-up.

        4. Objectives:

           Primary Objective:

           Evaluate the mortality related to Covid-19 in patients with a chronic liver disease

           Secondary objectives:

             -  Evaluate the mortality (liver-related and no liver-related) due to the Covid-19
                according to the cirrhotic status, an history of hepatocellular carcinoma, an
                immunosuppressive treatment and this type, the etiology-ies of liver disease at the
                infection (viral hepatitis -B and/or C-, related to alcohol consumption, metabolic
                syndrome, hemochromatosis, immune liver disease, other or unknown), and
                comorbidities

             -  Evaluate the liver morbidity related to Covid-19, including :

             -  incidence of liver biochemical abnormalities in patients with normal liver enzymes
                values or of a 2-fold increase of usual values for AST, ALT, GGT, alcalines
                phosphatasis

             -  incidence of liver complications (acute hepatitis, liver insufficiency,
                decompensation of cirrhosis, encephalopathy, renal insufficiency)

        5. Criteria:

           Primary criteria: mortality rate related to Covid-19 in patients with a chronic liver
           disease

           Secondary criteria:

             -  mortality rate according the stage of fibrosis and the cirrhotic status defined
                with liver biopsy or non invasive tests of fibrosis or according the opinion of
                clinician

             -  mortality related to Covid-19 according an history of hepatocellular carcinoma, an
                immunosuppressive treatment and this type (treatment related to a liver
                transplantation or to an auto-immune liver disease or to other indication), the
                etiology-ies of liver disease at the infection (viral hepatitis -B and/or C-,
                related to alcohol consumption, metabolic syndrome, hemochromatosis, immune liver
                disease, other or unknown), and comorbidities, particularly diabetes, hypertension,
                overweight -BMI from 26 to 30- or obesity-BMI > 30)

             -  Incidence of liver complications (acute hepatitis, liver insufficiency,
                decompensation of cirrhosis, encephalopathy, renal insufficiency)

        6. Effective and duration of the study:

           All consecutive patients included in the observatory with registered data in the eCRF
           until 31/12/20.

        7. Population of the study:

             -  Inclusion criteria:

             -  all patients with acute or chronic liver disease managed by a member of AFEF with
                positive diagnosis of COVID-19 by PCR and/or specific abnormalities at the thoracic
                TDM

             -  patients with history of liver transplantation

             -  patients affiliated with social security

             -  Non inclusion criteria: age equal or higher 18 years

        8. Conduct of the research:

      After informing patients and making available a non opposition form, the main demographic and
      clinical data related to a chronic liver disease, in one hand and, on the other hand, the
      COVID19, already collected in the patient's medical record will be collected in a dedicated
      eCRF. All contributors will be associated with the publications resulting from this
      observatory and the COVID-Foie working group.
    

Observational model: Cohort
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        All patients with a liver disease (chronic or acute) with a positive diagnosis of Covid-19
        assessed either by positive PCR or specific thoracic abnormalities at TDM
      
Keywords: Mortality; Fibrosis; Hepatocellular Carcinoma