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Decompensated Csirrhosis and COVID 19; Report of Two Cases
Majid Aghadavood1, Azam Teimouri1,2
1Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Coronavirus disease 2019 (COVID-19) can worsen cirrhosis decompensation. While one patient with cirrhosis and COVID-19 recovered with treatment and hemodialysis, another succumbed to the infection, highlighting the critical need for prevention in cirrhotic patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cirrhosis patients are vulnerable to decompensation, especially when co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- This report details two cases of cirrhosis patients presenting with severe illness, one complicated by SARS-CoV-2 infection.
Observation:
- An 82-year-old male with cirrhosis and hepatorenal syndrome showed COVID-19 on CT scan, improved with SARS-CoV-2 treatment and hemodialysis.
- A 59-year-old female with cirrhosis, hematemesis, and elevated creatinine had COVID-19 confirmed by RT-PCR and CT scan; she deteriorated despite hemodialysis and intubation, leading to cardiopulmonary arrest.
Findings:
- Coronavirus disease 2019 can precipitate or exacerbate decompensation in patients with underlying cirrhosis.
- Outcomes varied significantly, with one patient recovering and the other experiencing a fatal outcome despite intensive care.
Implications:
- COVID-19 poses a significant threat to patients with cirrhosis, potentially leading to severe complications and mortality.
- Preventing SARS-CoV-2 infection is paramount for managing patients with cirrhosis and improving their prognosis.
- Early recognition and tailored management, including supportive care like hemodialysis, may influence outcomes in selected cases.
Abstract:
Coronavirus disease 2019 (COVID-19) has turned to be the primary health concern worldwide and for critical patients in particular. Patients with cirrhosis may experience decompensation, as presented in the current case report. An 82-year-old man with cirrhosis was admitted for hepatorenal syndrome, and hemodialysis was initiated. Due to manifestations of COVID-19 in computed tomography (CT), the therapeutic protocols of coronavirus were initiated, and the patient was successfully rehabilitated by COVID-19 treatment and trice-a-week hemodialysis. The other case was a 59-year-old woman with cirrhosis and hematemesis, elevated creatinine, and progressive loss of consciousness. CT scan was compatible with COVID-19 confirmed by Real-time polymerase chain reaction (RT-PCR). Irresponsiveness to medical therapy led to four courses of hemodialysis. Respiratory distress led to intubation, and eventually, the cardiopulmonary arrest occurred, which led to unsuccessful cardiopulmonary resuscitation. Cirrhosis may be decompensated by COVID-19 and lead to fatal outcomes. Despite all the conventional efforts to help the patients survive, prevention from coronavirus infection remains the mainstay for patients with cirrhosis.
