Survival and outcomes for co-infection of chronic hepatitis C with and without cirrhosis and COVID-19: A multicenter retrospective study

BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.METHODS This multicenter,retrospective cohort study included all cases of confirmed coinfection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals(Al-Sahel Hospital,Al-Matareya Hospital,Al-Ahrar Hospital,Ahmed Maher Teaching Hospital,Al-Gomhoreya Hospital,and the National Hepatology and Tropical Medicine Research Institute)affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt.Patients were recruited from May 1,2020,to July 31,2020.Demographic,laboratory,imaging features,and outcomes were collected.Multivariate regression analysis was performed to detect factors affecting mortality.RESULTS This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection,of which 64(51.20%)had liver cirrhosis and 40(32.00%)died.Fever,cough,dyspnea,and fatigue were the most frequent symptoms in patients with liver cirrhosis.Cough,sore throat,fatigue,myalgia,and diarrhea were significantly more common in patients with liver cirrhosis than in noncirrhotic patients.There was no difference between patients with and without cirrhosis regarding comorbidities.Fifteen patients(23.40%)with liver cirrhosis presented with hepatic encephalopathy.Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans:28(43.75%)vs 4(6.55%),respectively(P value<0.001).These patients also were more likely to have severe COVID-19 infection,compared to patients without liver cirrhosis:29(45.31%)vs 11(18.04%),respectively(P value<0.003).Mortality was higher in patients with liver cirrhosis,compared to those with no cirrhosis:33(51.56%)vs 9(14.75%),respectively(P value<0.001).All patients in Child-Pugh class A recovered and were discharged.Cirrhotic mortality occurred among decompensated patients only.A multivariate regression analysis revealed the following independent factors affecting mortality:Male gender(OR 7.17,95%CI:2.19–23.51;P value=0.001),diabetes mellitus(OR 4.03,95%CI:1.49–10.91;P value=0.006),and liver cirrhosis(OR 1.103,95%CI:1.037–1.282;P value<0.0001).We found no differences in liver function,COVID-19 disease severity,or outcomes between patients who previously received direct-acting antiviral therapy(and achieved sustained virological response)and patients who did not receive this therapy.CONCLUSION Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19.Male gender,diabetes mellitus,and liver cirrhosis are independent factors associated with increased mortality risk.

Effect of Bilateral Ultrasound-Guided Quadratus Lumborum Block versus Lumbar Epidural Block on Postoperative Analgesia following Major Lower Abdominal Cancer Surgery

Background: Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. Aim: To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. Methods: The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. Results: Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. Limitation: Small sample size and shorter period for postoperative follow-up. Conclusions: Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.