Immune Response and Risk of Decompensation following SARS-CoV-2 Infection in Outpatients with Advanced Chronic Liver Disease

• Published in: International journal of molecular sciences Vol. 25; no. 15; p. 8302
• Main Authors: Brujats, Anna, Huerta, Anna, Osuna-Gómez, Rubén, Guinart-Cuadra, Albert, Ferrero-Gregori, Andreu, Pujol, Clàudia, Soriano, German, Poca, Maria, Fajardo, Javier, Escorsell, Angels, Gallego, Adolfo, Vidal, Silvia, Villanueva, Càndid, Alvarado-Tapias, Edilmar
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.08.2024
• Subjects: advanced chronic liver disease (ACLD); Aged; anti-Spike 1 immunoglobulin G; Antigens; Ascites; B cells; Bacterial infections; Case-Control Studies; Chronic Disease; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - immunology; decompensation; Development and progression; Female; Genotype & phenotype; Health aspects; Hemoglobin; Humans; immune response; Immunoglobulin G - blood; Immunoglobulin G - immunology; Immunoglobulins; Infection; Infections; Liver cirrhosis; Liver diseases; Liver Diseases - epidemiology; Liver Diseases - immunology; Liver Diseases - virology; Male; Middle Aged; Mortality; Outpatients; Prospective Studies; Risk Factors; SARS-CoV-2 - immunology; SARS-CoV-2 infection; Severe acute respiratory syndrome coronavirus 2; Spain; Viral infections; Spain; SARS-CoV-2 infection; advanced chronic liver disease (ACLD); anti-Spike 1 immunoglobulin G; immune response; decompensation
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms25158302

Advanced chronic liver disease (ACLD) is associated with a wide spectrum of immune dysfunction. The clinical impact of SARS-CoV-2 on the development of decompensation and immune response in unvaccinated outpatients has not as yet been clearly defined. This study aimed to evaluate the clinical and immunological impact of SARS-CoV-2 on outpatients with ACLD. This is an observational case-control study, in which ACLD outpatients were included prospectively and consecutively and classified into two groups: SARS-CoV-2 infected and non-infected. Patients' baseline characteristics and infection data were collected and analyzed. Immunoglobulin G (IgG) levels against Spike 1 were evaluated. The primary endpoint was risk of liver decompensation during follow-up, assessed after propensity score matching and adjusted by Cox regression. Between October 2020 and July 2021, ACLD outpatients (n = 580) were identified, and 174 patients with clinical follow-up were included. SARS-CoV-2 infection incidence was 7.6% (n = 44). Risk of liver decompensation was significantly higher after infection (HR = 2.43 [1.01-5.86], = 0.048) vs. non-infection. The time of IgG evaluation was similar in all patients (n = 74); IgG concentrations were significantly higher in compensated vs. decompensated patients (1.02 ± 0.35 pg/mL vs. 0.34 ± 0.16 pg/mL, < 0.0001) and correlated with hemoglobin levels. The dysregulation of the innate immune response in patients with decompensated liver disease increased the risk of further decompensation following SARS-CoV-2, mainly due to a worsening of ascites.