Real-Life Experience in the Efficacy and Safety of COVID-19 Vaccination in Patients with Advanced Cirrhosis

Amr Shaaban Hanafy; Ahmed Embaby; Sara Mohamed Salem; Ahmed Behiry; Hasnaa Ali Ebrahim; Hany Ahmed Elkattawy; Sally Yussef Abed; Moneer E Almadani; Mohamad El-Sherbiny

doi:10.3390/jcm12247578

Real-Life Experience in the Efficacy and Safety of COVID-19 Vaccination in Patients with Advanced Cirrhosis

J Clin Med. 2023 Dec 8;12(24):7578. doi: 10.3390/jcm12247578.

Authors

Affiliations

¹ Internal Medicine Department, Gastroenterology and Hepatology Division, Zagazig University, Zagazig 44519, Egypt.
² Clinical Hematology Unit, Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
³ Department of Tropical Medicine and Endemic Diseases, College of Medicine, Zagazig University, Zagazig 44519, Egypt.
⁴ Department of Basic Medical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
⁵ Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh 11597, Saudi Arabia.
⁶ Medical Physiology Department, College of Medicine, Zagazig University, Zagazig 44519, Egypt.
⁷ Department of Respiratory Care, College of Applied Medical Science in Jubail, Imam Abdulrahman Bin Faisal University, Jubail 34212, Saudi Arabia.
⁸ Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
⁹ Department of Clinical Medical Sciences, College of Medicine, AlMaarefa University, Riyadh 11597, Saudi Arabia.

Abstract

COVID-19 infections accelerate liver decompensation and serious liver-related co-morbidities. The aim is to evaluate the safety and impact of COVID vaccines on hepatic disease progression in patients with advanced liver disease and to identify parameters that predict the occurrence of complications. The study involved 70 patients with advanced liver disease who were vaccinated with different COVID vaccines from January 2021 to April 2022. They were evaluated clinically. The laboratory investigation included a complete blood count, liver and kidney function tests, calculation of CTP and MELD scores, plasma levels of ammonia, abdominal ultrasound, and upper GI endoscopy. Twenty patients had experienced complications 64 ± 12 days from the last dose of a vaccination. Twenty patients (28.6%) developed hepatic decompensation and hypothyroidism (n = 11, 15.7%), and five (7.14%) patients developed splanchnic thrombosis. There were no COVID-19 reinfections except for two patients who received Sinopharm and developed vaccine-associated enhanced disease (2.9%). Complications after COVID vaccinations were correlated with ALT (r = 0.279, p = 0.019), serum sodium (r = -0.30, p = 0.005), creatinine (r = 0.303, p = 0.011), liver volume (LV) (r = -0.640, p = 0.000), and MELD score (r = 0.439, p = 0.000). Multivariate logistic regression revealed that LV is the only independent predictor (p = 0.001). LV ≤ 682.3 has a sensitivity of 95.24% and a specificity of 85.71% in predicting complications with an AUC of 0.935, p < 0.001. In conclusion, the hepatic reserve and prognosis in liver cirrhosis should be evaluated prior to COVID vaccinations using the MELD score and liver volume as promising risk stratification criteria. In summary, the research proposes a novel triaging strategy that involves utilizing the MELD score and liver volume as risk stratification parameters of the hepatic reserve and prognosis of advanced liver cirrhosis prior to COVID immunization to determine who should not receive a COVID vaccination.

Keywords: COVID-19; MELD; complications; liver cirrhosis; liver volume; vaccines.

Grants and funding

This research was funded by the Princess Nourah bint Abdulrahman University, Researcher Supporting Project number (PNURSP2023R171); the Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia and by AlMaarefa University, Riyadh, Saudi Arabia.