faa3e96d082fb2e0aa6adc4bcf25ea63 300122.pdf f4069316c895f738cdfad12d570ef24f1154b770 300122.pdf 2764bab7e322d646ff8da5eea86356c030a994fccb95b7015e3a5192b6e682df 300122.pdf Title: Immune Response and Risk of Decompensation following SARS-CoV-2 Infection in Outpatients with Advanced Chronic Liver Disease Subject: Advanced chronic liver disease (ACLD) is associated with a wide spectrum of immune dysfunction. The clinical impact of SARS-CoV-2 on the development of decompensation and immune response in unvaccinated outpatients has not as yet been clearly defined. This study aimed to evaluate the clinical and immunological impact of SARS-CoV-2 on outpatients with ACLD. This is an observational case–control study, in which ACLD outpatients were included prospectively and consecutively and classified into two groups: SARS-CoV-2 infected and non-infected. Patients’ baseline characteristics and infection data were collected and analyzed. Immunoglobulin G (IgG) levels against Spike 1 were evaluated. The primary endpoint was risk of liver decompensation during follow-up, assessed after propensity score matching and adjusted by Cox regression. Between October 2020 and July 2021, ACLD outpatients (n = 580) were identified, and 174 patients with clinical follow-up were included. SARS-CoV-2 infection incidence was 7.6% (n = 44). Risk of liver decompensation was significantly higher after infection (HR = 2.43 [1.01–5.86], p = 0.048) vs. non-infection. The time of IgG evaluation was similar in all patients (n = 74); IgG concentrations were significantly higher in compensated vs. decompensated patients (1.02 0.35 pg/mL vs. 0.34 0.16 pg/mL, p < 0.0001) and correlated with hemoglobin levels. The dysregulation of the innate immune response in patients with decompensated liver disease increased the risk of further decompensation following SARS-CoV-2, mainly due to a worsening of ascites. Keywords: advanced chronic liver disease (ACLD); decompensation; SARS-CoV-2 infection; immune response; anti-Spike 1 immunoglobulin G Author: Anna Brujats, Anna Huerta, Rubén Osuna-Gómez, Albert Guinart-Cuadra, Andreu Ferrero-Gregori, Clàudia Pujol, German Soriano, Maria Poca, Javier Fajardo, Angels Escorsell, Adolfo Gallego, Silvia Vidal, Càndid Villanueva and Edilmar Alvarado-Tapias Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue Jul 30 08:09:30 2024 CEST ModDate: Tue Jul 30 08:16:05 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1046490 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PURWBA+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 CYHDQZ+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 HRNGEE+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 GDKDGQ+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 CZMDWU+CMSY10 Type 1 Builtin yes yes yes 32 0 BAHZVY+VnURWPalladioL Type 1 Custom yes yes yes 37 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 53 0 CKUPDE+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 56 0 LAJOEP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 85 0 LAJOFB+PalatinoLinotype TrueType WinAnsi yes yes no 88 0 LAJOFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 91 0 LAJOLC+PalatinoLinotype TrueType MacRoman yes yes no 94 0 CAMXTK+EURM10 Type 1 Builtin yes yes yes 101 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 106 0 LAJOEP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 121 0 LAJOFB+PalatinoLinotype TrueType WinAnsi yes yes no 124 0 LAJOFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 127 0 LAJOLC+PalatinoLinotype TrueType MacRoman yes yes no 130 0 LAJPHA+Symbol Type 1C Custom yes yes yes 169 0 LAJOEP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 174 0 LAJOFA+PalatinoLinotype CID TrueType Identity-H yes yes yes 177 0 LAJOFB+PalatinoLinotype TrueType WinAnsi yes yes no 183 0 LAJOFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 186 0 LAJOLC+PalatinoLinotype TrueType MacRoman yes yes no 189 0 LAJPGA+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 192 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-12-28 02:37:34 CET RepresentationInformation: 300122.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-19 09:57:16 CET Size: 1046490 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 388 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Children: Item: Title: Study Population Destination: subsection.2.1 Item: Title: Characterization of Infected and Non-Infected Patients Destination: subsection.2.2 Item: Title: Clinical Characteristics and Outcomes in Matched Populations Destination: subsection.2.3 Item: Title: Discussion Destination: section.3 Item: Title: Materials and Methods Destination: section.4 Children: Item: Title: Study Design and Participants Destination: subsection.4.1 Item: Title: Data Collection and Serological Study Destination: subsection.4.2 Item: Title: Statistical Analysis Destination: subsection.4.3 Item: Title: References Destination: appendix.A. Info: Title: Immune Response and Risk of Decompensation following SARS-CoV-2 Infection in Outpatients with Advanced Chronic Liver Disease Author: Anna Brujats, Anna Huerta, Rubén Osuna-Gómez, Albert Guinart-Cuadra, Andreu Ferrero-Gregori, Clàudia Pujol, German Soriano, Maria Poca, Javier Fajardo, Angels Escorsell, Adolfo Gallego, Silvia Vidal, Càndid Villanueva and Edilmar Alvarado-Tapias Subject: Advanced chronic liver disease (ACLD) is associated with a wide spectrum of immune dysfunction. The clinical impact of SARS-CoV-2 on the development of decompensation and immune response in unvaccinated outpatients has not as yet been clearly defined. This study aimed to evaluate the clinical and immunological impact of SARS-CoV-2 on outpatients with ACLD. This is an observational case control study, in which ACLD outpatients were included prospectively and consecutively and classified into two groups: SARS-CoV-2 infected and non-infected. Patients’ baseline characteristics and infection data were collected and analyzed. Immunoglobulin G (IgG) levels against Spike 1 were evaluated. The primary endpoint was risk of liver decompensation during follow-up, assessed after propensity score matching and adjusted by Cox regression. Between October 2020 and July 2021, ACLD outpatients (n = 580) were identified, and 174 patients with clinical follow-up were included. SARS-CoV-2 infection incidence was 7.6% (n = 44). Risk of liver decompensation was significantly higher after infection (HR = 2.43 [1.01 5.86], p = 0.048) vs. non-infection. The time of IgG evaluation was similar in all patients (n = 74); IgG concentrations were significantly higher in compensated vs. decompensated patients (1.02 0.35 pg/mL vs. 0.34 0.16 pg/mL, p < 0.0001) and correlated with hemoglobin levels. The dysregulation of the innate immune response in patients with decompensated liver disease increased the risk of further decompensation following SARS-CoV-2, mainly due to a worsening of ascites. 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