covid-19 & cirrosis hepática
TRANSCRIPT
![Page 1: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/1.jpg)
COVID-19 & Cirrosis HepáticaVirginia Hernández-GeaUnidad Hemodinámica Hepática
Liver Unit. Hospital Clinic-IDIBAPS
![Page 2: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/2.jpg)
Hepatotropismo SARS- CoV-2
Wang Y et al. J Hepatol 2020; Sonzogni A et al. Liver Int 2020
Coronavirus- like particles in hepatocyte cytoplasmin association with mitochondrial swelling & apoptosis
Histological assessment post-mortem liver biopsy from 48 patients dying from severe COVID-19 lung disease:
vascular abnormalities (100%)portal venous and sinusoidal microthromboses
microvesicular and macrovesicular steatosis (50%)mild portal inflammation (66%)portal fibrosis (60%)
![Page 3: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/3.jpg)
Daño hepático en pacientes con COVID-19
Estudio con 417 pacientes con COVID-19: 318 (76.3%) alteración PFH*90 (21.5%) daño hepático durante ingreso Cai Q et al. J Hepatol 2020
* ALT >40 U/L, AST >40 U/L, GGT >49 U/L, ALP >135 U/L, & total bilirubin >17.1 lmol/L
![Page 4: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/4.jpg)
Daño hepático en pacientes con COVID-19
Guan W et al. N Engl J Med 2020
Alteracion transitoriaNo casos IHAG
¿Efecto citopatico directo del virus?Sepsis grave, inestabilidad hemodinamica, ventilacionmecanica…
¿Tiene valor pronóstico?Resultados controvertidos en la asociacion citolisis y mortalidad
![Page 5: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/5.jpg)
745 pacientes con CLD & SARS-CoV-2 386 con cirrosis359 sin cirrosis
(2 registros internacionales US & EU)
643 pacientes con SARS-CoV-2 (Oxford University Hospitals NHS Foundation Trust)
![Page 6: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/6.jpg)
Infección por SARS-CoV2 & enfermedad hepática
No diferenciastasa hospitalizacion Tec depuracio renal
![Page 7: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/7.jpg)
Infección por SARS-CoV2 & enfermedad hepática
Mayor tasa de:Requerimiento UCITec. depuracion renalVentilación invasivaMuerte
![Page 8: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/8.jpg)
Infección por SARS-CoV2 & enfermedad hepática
Mortalidad por franja de edad
![Page 9: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/9.jpg)
Infección por SARS-CoV2 & enfermedad hepática
Marjot T et al. Nat Rev Gastroenterol Hepatol 2021
![Page 10: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/10.jpg)
Curso clínico de la infección SARS-CoV-2 en CLD
![Page 11: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/11.jpg)
![Page 12: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/12.jpg)
Possible mechanisms for adverse CoVID-19 outcomes in cirrhosis
Marjot T et al. Nat Rev Gastroenterol Hepatol 2021
![Page 13: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/13.jpg)
Possible mechanisms for adverse CoVID-19 outcomes in cirrhosis
Marjot T et al. Nat Rev Gastroenterol Hepatol 2021
![Page 14: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/14.jpg)
Vacunas y cirrosis
![Page 15: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/15.jpg)
Vacunas y cirrosis Cirrosis: inflamacion sistemica y disfuncion inmune innata/adaptativaRespuesta alterada a vacunas (neumococo, hepatitis B)Respuesta a la vacuna en cirrosis (inmunidad humoral y celular)?
![Page 16: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/16.jpg)
Infección por SARS-CoV2 & Enfermedad Vascular Hepática
1234 patients
559 splanchnic thrombosis 158 BCS 268 PSVD
72 SarsCOV2 infection
487 notinfected
9 SarsCOV2 infection
149 notinfected
48 SarsCOV2 infection
220 notinfected
250 patients excluded due to impossibility to reach them
Baiges A et al. Unpublished
![Page 17: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/17.jpg)
Infección por SARS-CoV2 & Enfermedad Vascular Hepática
6,50%
18%
13%
6%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
GP PSVD SVT BCS
Incidencia global
Baiges A et al. Unpublished
![Page 18: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/18.jpg)
Infección por SARS-CoV2 & Enfermedad Vascular Hepática
Incidencia por grupo edad
7%
9%
11%
6% 6,40%
25%
15%
6% 5,30%
19%
13%
4%5,40%
10%
13%
6%
0%
5%
10%
15%
20%
25%
30%
<40 PSVD SVT BCS 40-59
PSVD SVT BCS 60-69
PSVD SVT BCS >70 PSVD SVT BCS
<40 40-59 60-69
n= 56 n =117 n= 34 n=119 n=259 n=83 n=53 n=98 n=23 n=40 n=84 n= 17
GP
GP
GP
GP
>70 Baiges A et al. Unpublished
![Page 19: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/19.jpg)
Infección por SARS-CoV2 & Enfermedad Vascular Hepática
Baiges A et al. Unpublished
![Page 20: COVID-19 & Cirrosis Hepática](https://reader030.vdocument.in/reader030/viewer/2022012417/61728bb42ed38438417ff2b1/html5/thumbnails/20.jpg)
Gracias