Progression of hepatic encephalopathy in patients with liver cirrhosis in COVID-19

Abstract

Introduction. Patients with chronic liver disease are at increased risk of severe illness and death after SARS-CoV-2 infection, and COVID-19 exacerbates liver damage in patients with chronic liver disease. The purpose of the study: to determine the dynamics of hepatic encephalopathy (HE) signs in patients with liver cirrhosis (LC) with COVID-19. Object and research methods. We examined 52 patients with LC and HE after COVID-19. All examined patients underwent general clinical examinations and neuropsychometric testing. Research results and their discussion. In patients with LC and COVID-19, progression of liver damage was found: a significant decrease in patients with LC class A (compensation stage) by 7.7% (p<0.05), accompanied by an increase in patients with LC class C (decompensation stage) – by 11.5% (p<0.05) one month after an acute respiratory infection caused by SARS-CoV-2 virus. Patients with LC after COVID-19 often had complaints of dizziness, headache, memory and attention impairment, difficulty and slowing down in performing everyday practical skills, irritability, periodic apathy, and anxiety. Determination of the severity of clinical manifestations of HE in the examined patients with LC after discharge from the hospital with COVID-19 indicates the prevalence of patients with grade I-II of HE in sub- and decompensation of LC, while patients with latent HE predominate in compensation of the disease. In the control examination of patients after 1 month, the progression of signs of HE was established. An increase in the number of patients with LC with grade II of HE in Child-Pugh classes B and C was found against the background of a decrease in patients with latent HE and grade I HE. With progression and decompensation of LC, 16.7% of patients were diagnosed with grade III of HE. Conclusions. 1. In patients with cirrhosis, signs of HE clinically are manifested by impaired cognitive function, mood and behavior and progress from minimal manifestations in patients with compensation of the disease to the most pronounced changes in the decompensation of the cirrhotic process. 2. Clinical manifestation of HE in patients with LC after COVID-19 tend to progress in the post-COVID-19 period.