Influence of Chronic Liver Diseases on the Course and Outcome of COVID-19

Nikola Mitrovic, Milos Sabanovic, Ankica Vujovic, Jaroslava Jovanovic, Natasa Nikolic, Martina Jug, Nevena Todorovic, Ana Filipovic, Ivana Milosevic


Coronavirus disease of 2019 (COVID-19) is a global health problem. The impact of chronic liver diseases on the course and outcome of COVID-19 is still the subject of research. The aim of this study was to show the characteristics of COVID-19 patients with chronic liver diseases, and to establish the risk factors for unfavourable outcome.


Coronavirus disease of 2019 (COVID-19) is a global health problem, and the pandemic has affected almost all countries of the world. According to data from the World Health Organisation (WHO), so far more than 660 million people around the world have become ill with the disease and more than 6.7 million have died [1]. COVID-19 infection is characterized with inflammation and usually presents with mild flu like symptoms [2, 3]. However, it can also progress to more serious course [4]. The clinical picture varies from mild and almost asymptomatic forms of the illness to severe, life-threatening forms accompanied by respiratory failure, sepsis, septic shock, and multiple organ dysfunction. It is an illness with the possibility of affecting different organ systems.


To provide an answer to the question that was posed, a retrospective observational study was conducted on subjects with a previously established diagnosis of chronic liver disease (CLD) and a confirmed case of COVID-19. They were treated at the Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia during the current COVID-19 pandemic between 15 March 2020 and 15 March 2022. All the protocols performed in this study were in accordance with the ethical guidelines of the Declaration of Helsinki. Ethical approval for this study was obtained from the Ethics Committee of the University Clinical Center of Serbia. Written informed consent was obtained from each patient included in the study. The criteria of inclusion in the study were a confirmed SARS-CoV-2 infection with viral DNA detection carried out by a PCR method using a nose and throat swab, and the presence of a CLD made at least six months prior to infection.


Within the timeframe of two years 80 patients with CLD who contracted COVID-19 were included in the study; of these 59 (73.8%) were male and 21 (26.3%) were female. The average age was 55.5±14.3 years, with a range of 20–78 years. Of these, 49 (61.2%) were of average constitution (BMI 18.5–24.9 kg/m2), 7 (8.8%) were underweight (BMI <18.5 kg/m2), while 24 (30%) were overweight (BMI>25 kg/m2). Of the CLDs, the greatest number were with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections– 27, somewhat fewer were with NAFLD– 24, while other causes were less represented.


Considering that there is still no end in sight for the COVID-19 pandemic, physicians should be aware that liver cirrhosis and severe pneumonia were shown in the study to be independent unfavourable predictors of lethal outcome for persons with CLD infected with the SARS-CoV-2. Furthermore, the rest of the risk factors that univariate statistical analysis showed to be significant predictors of an unfavourable outcome, such as ALD, elevated transaminase values, malignancies as associated comorbidities, and advance age, must not be overlooked.

Citation: Mitrovic N, Sabanovic M, Vujovic A, Jovanovic J, Nikolic N, Jug M, et al. (2023) Influence of chronic liver diseases on the course and outcome of COVID-19. PLoS ONE 18(7): e0288350.

Editor: Gulali Aktas, Bolu Abant İzzet Baysal University: Bolu Abant Izzet Baysal Universitesi, TURKEY

Received: February 27, 2023; Accepted: June 24, 2023; Published: July 14, 2023

Copyright: © 2023 Mitrovic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.