Real-Life Experience in the Efficacy and Safety of COVID-19 Vaccination in Patients with Advanced Cirrhosis

被引：1

作者：

Hanafy, Amr Shaaban ^{[1
]}

Embaby, Ahmed ^{[2
]}

Salem, Sara Mohamed ^{[1
]}

Behiry, Ahmed ^{[3
]}

Ebrahim, Hasnaa Ali ^{[4
]}

Elkattawy, Hany Ahmed ^{[5
,6
]}

Abed, Sally Yussef ^{[7
,8
]}

Almadani, Moneer E. ^{[9
]}

El-Sherbiny, Mohamad ^{[5
]}

机构：

[1] Zagazig Univ, Internal Med Dept, Gastroenterol & Hepatol Div, Zagazig 44519, Egypt

[2] Zagazig Univ, Fac Med, Internal Med Dept, Clin Hematol Unit, Zagazig 44519, Egypt

[3] Zagazig Univ, Fac Med, Dept Trop Med & Endem Dis, Zagazig 44519, Egypt

[4] Princess Nourah bint Abdulrahman Univ, Coll Med, Dept Basic Med Sci, PO Box 84428, Riyadh 11671, Saudi Arabia

[5] AlMaarefa Univ, Coll Med, Dept Basic Med Sci, Riyadh 11597, Saudi Arabia

[6] Zagazig Univ, Coll Med, Med Physiol Dept, Zagazig 44519, Egypt

[7] Imam Abdulrahman Bin Faisal Univ, Coll Appl Med Sci Jubail, Dept Resp Care, Jubail Ind City 34212, Saudi Arabia

[8] Mansoura Univ, Fac Med, Trop Med Dept, Mansoura 35516, Egypt

[9] AlMaarefa Univ, Coll Med, Dept Clin Med Sci, Riyadh 11597, Saudi Arabia

来源：

JOURNAL OF CLINICAL MEDICINE | 2023年 / 12卷 / 24期

关键词：

COVID-19; vaccines; complications; MELD; liver cirrhosis; liver volume; CLINICAL CHARACTERISTICS; SARS-COV-2; MANAGEMENT; CANCER; RISK;

D O I：

10.3390/jcm12247578

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

COVID-19 infections accelerate liver decompensation and serious liver-related co-morbidities. The aim is to evaluate the safety and impact of COVID vaccines on hepatic disease progression in patients with advanced liver disease and to identify parameters that predict the occurrence of complications. The study involved 70 patients with advanced liver disease who were vaccinated with different COVID vaccines from January 2021 to April 2022. They were evaluated clinically. The laboratory investigation included a complete blood count, liver and kidney function tests, calculation of CTP and MELD scores, plasma levels of ammonia, abdominal ultrasound, and upper GI endoscopy. Twenty patients had experienced complications 64 +/- 12 days from the last dose of a vaccination. Twenty patients (28.6%) developed hepatic decompensation and hypothyroidism (n = 11, 15.7%), and five (7.14%) patients developed splanchnic thrombosis. There were no COVID-19 reinfections except for two patients who received Sinopharm and developed vaccine-associated enhanced disease (2.9%). Complications after COVID vaccinations were correlated with ALT (r = 0.279, p = 0.019), serum sodium (r = -0.30, p = 0.005), creatinine (r = 0.303, p = 0.011), liver volume (LV) (r = -0.640, p = 0.000), and MELD score (r = 0.439, p = 0.000). Multivariate logistic regression revealed that LV is the only independent predictor (p = 0.001). LV <= 682.3 has a sensitivity of 95.24% and a specificity of 85.71% in predicting complications with an AUC of 0.935, p < 0.001. In conclusion, the hepatic reserve and prognosis in liver cirrhosis should be evaluated prior to COVID vaccinations using the MELD score and liver volume as promising risk stratification criteria. In summary, the research proposes a novel triaging strategy that involves utilizing the MELD score and liver volume as risk stratification parameters of the hepatic reserve and prognosis of advanced liver cirrhosis prior to COVID immunization to determine who should not receive a COVID vaccination.

引用

页数：14