Бадамначин, Батсүх

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Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)
(Springer Science and Business Media LLC, 2020-09)
Sarin, Shiv Kumar
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Choudhury, Ashok
;
Lau, George K
;
Zheng, Ming-Hua
;
Ji, Dong
BACKGROUND AND AIMS: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. METHODS: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. RESULTS: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. CONCLUSIONS: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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One-year antibody kinetics and effectiveness of a BNT162b2 booster after four primary COVID-19 vaccination regimens in Mongolia
(2026-09)
Bazarjav, Purevbat
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Erdene-Ochir, Tseyenkhorloo
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Sandagdorj, Ankhbayar
;
Enkhtuvshin, Altansukh
;
Enkhbayar, Purevjargal
BACKGROUND: Waning immunity after primary COVID-19 vaccination and the widespread use of heterogeneous vaccine platforms have created uncertainty regarding the durability of protection following booster vaccination. Mongolia implemented a mixed-platform vaccination program and deployed BNT162b2 as a booster. We evaluated the immunogenicity, effectiveness, and safety of a BNT162b2 booster following four primary vaccination regimens with 12 months follow-up. METHODS: In this prospective observational study in Ulaanbaatar, Mongolia, adults (≥18 years) who had completed a homologous two-dose primary series with BBIBP-CorV, ChAdOx1 nCoV-19, Gam-COVID-Vac, or BNT162b2 received a BNT162b2 booster a median of 189 days (IQR 186-215) after the second dose and were grouped according to their primary vaccination regimen. Humoral immune responses (anti-SARS-CoV-2 N/S1-RBD IgG, S-RBD IgG, and neutralizing antibodies) were measured at baseline and at multiple time points up to 12 months after booster vaccination. Reactogenicity was monitored for 28 days. SARS-CoV-2 infection was ascertained by a positive antigen/lateral-flow test and/or RT-PCR. VE was estimated for prespecified follow-up intervals by comparing the risk of SARS-CoV-2 infection in each boosted group with that in an unvaccinated comparison group. FINDINGS: Among 311 participants (mean age 41.88 years [SD 13.64]; 175 [56.27%] women and 136 [43.73%] men), antibody responses peaked at day 14 and declined through day 365 in all groups. At day 14, total antibody concentrations were highest in BNT + BNT (385.03 U/mL) and lowest in Gam + BNT (341.74 U/mL). S-RBD IgG at day 14 was highest in BNT + BNT (967.0 ng/mL) and lowest in BBIBP+BNT (863.70 ng/mL). Neutralizing antibodies at day 14 were highest in BNT + BNT (368.13 AU/mL) and BBIBP+BNT (336.70 AU/mL). During follow-up, 64 participants acquired SARS-CoV-2 infection and 15 (23.44%) were admitted to hospital. Reactogenicity was predominantly mild-to-moderate, and laboratory parameters were generally within acceptable ranges. Vaccine effectiveness declined from 1 month to 12 months: BBIBP+BNT 90.54% (95% CI 59.71-97.78) to 71.17% (39.66-86.23); ChAd+BNT 84.97% (49.75-95.51) to 52.59% (8.61-75.41); Gam + BNT 89.68% (23.95-98.60) to 63.84% (15.10-84.60); BNT + BNT 91.89% (40.06-98.90) to 72.29% (34.37-88.30). INTERPRETATION: A BNT162b2 booster following diverse primary COVID-19 vaccination regimens induced strong humoral responses that declined over 12 months and showed an acceptable reactogenicity profile. VE against SARS-CoV-2 infection was highest soon after boosting and lower later in follow-up. Although antibody levels and VE showed similar temporal patterns, these findings should be interpreted as complementary outcomes rather than evidence of a direct causal relationship or a formal immunological correlate of protection.

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