COVID19-FOIE National Observatory. An Ambispective Cohort Study of All Consecutive Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,132
- 试验地点
- 1
- 主要终点
- Mortality rate related to Covid-19 in patients with a chronic liver disease
研究概览
简要总结
Background:
The COVID19 and liver relationships are very rare. The preliminary Chinese data indicate that 2-11% of patients treated for COVID19 had an underlying chronic liver disease. However, there is no clinical data on morbi-mortality in this context.
Objectives:
Primary Objective:
Evaluate the mortality related to Covid-19 in patients with a chronic liver disease
Secondary objectives:
- Evaluate the mortality (liver-related and no liver-related) due to the Covid-19 according to the cirrhotic status, an history of hepatocellular carcinoma, an immunosuppressive treatment and its type, the etiology-ies of liver disease at the diagnosis of Covid-19 (viral hepatitis -B and/or C-, liver disease related to alcohol consumption, metabolic syndrome, hemochromatosis, immune liver disease, other or unknown), and comorbidities
- Evaluate the liver morbidity related to Covid-19, including
- incidence of liver biochemical abnormalities in patients with normal liver enzymes values or of a 2-fold increase of usual values for AST, ALT, GGT, Alcalines Phosphatasis
- incidence of liver complications (acute hepatitis, liver insufficiency, decompensation of cirrhosis, encephalopathy, renal insufficiency)
Patients:
All patients with a liver disease (chronic or acute) with a positive diagnosis of Covid-19 assessed either by positive PCR or specific thoracic abnormalities at TDM
Methodology:
Observational ambispective study consisting exclusively of a collection of data from patients with liver diseases and managed for COVID 19 The data is collected and transcribed on a secure electronic eCRF hosted at the Assitance Publique des Hôpitaux de Paris and accessible online from the AFEF website
Duration and organisation of the research:
After information of the patients and making available a non-opposition form, the main demographic and clinical data related to the liver disease and to the COVID19 already collected in the patient's medical record will be collected in a dedicated e-CRF.
Effective of the study:
All consecutive patients included in the study whose data are collected e-CRF until 31/12/2020.
详细描述
- Background and objectives:
Coronavirus infection 2019 (COVID-19), linked to the SARS-Cov-2 virus, is rapidly spreading worldwide. After the city of Wuhan and the province of Hubei, European healthcare systems are facing an outbreak of seriously ill patients, but few are fully equipped to manage this health crisis.
On the occasion of this pandemic, the hepatologist associations of United States , Europe and France as well as the French Federation of Digestive Cancer have proposed modalities for the management of patients with chronic liver disease likely to guarantee them maximum safety. The level of scientific evidence for these proposals is very low, given the small amount of objective clinical data available to date on the relationship between COVID-19 and liver.
Some preliminary Chinese data indicates that:
- 2-11% of patients treated for COVID19 had underlying chronic liver disease
- an increase in transaminases is observed in 25-35% of patients, generally moderate (median 23-39 IU/L), with a higher rate in symptomatic and/or severe forms and/or requiring hospitalization in intensive care unit as well as in patients who later die . The mechanism involved is uncertain to date. Indeed, the data suggesting the possibility of localization of the virus in the liver are too preliminary, and it is reasonable to incriminate the elements of inflammatory reaction syndrome. Liver damage can be explained during these infections by hepatic hypoxia, related to a frequent viral myocarditis in this situation. Finally, other more classic causes may also be associated, including drug (paracetamol, antibiotics), or an exacerbation of an underlying chronic liver disease, known or unknown. Control of viral serologies B and C is therefore recommended in this situation.
- elderly patients, patients with cirrhosis, patients with immune hepatitis under immunosuppressive drugs and patients before and after transplantation under immunosuppressive therapy would be the subjects most at risk of severe COVID19
- very strict preventive measures have proven their effectiveness in terms of mortality in 111 patients with decompensated cirrhosis, including 2/3 hospitalized and 1/3 ambulatory.
In this totally new and unexpected context, the board meeting of the AFEF proposes the national observatory COVID19-FOIE, intended to collect data of patients with liver disease (all stages combined) or liver transplants that developed COVID19 confirmed by PCR on nasopharyngeal sampling and/or thoracic CT. 2. Population:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients with acute or chronic liver disease managed by a member of AFEF with positive diagnosis of COVID-19 by PCR and/or specific abnormalities at the thoracic TDM
- •Patients with history of liver transplantation
- •Patients affiliated with social security
排除标准
- •Age inferior to 18 years
结局指标
主要结局
Mortality rate related to Covid-19 in patients with a chronic liver disease
时间窗: Up to 30 days
次要结局
- mortality rate according the stage of fibrosis and the cirrhotic status(Up to 30 days)
- mortality related to Covid-19 according an history of hepatocellular carcinoma, an immunosuppressive treatment and this type the etiology-ies of liver disease at the infection and comorbidities.(Up to 30 days)
- Incidence of liver complications(through patient follow-up, an average of 1 year)