In the hitherto existing Coronavirus Disease 2019 ( COVID-19 )pandemic era, physicians across the globe are reporting a large number of extrapulmonary manifestations of the SARS COV2 virus including acute liver injury. At the same time, there is emerging clinical evidence that individuals with advanced liver disease are at a higher risk of acquiring COVID 19 and have a poorer prognosis compared to normal healthy individuals. This raises many questions in the minds of individuals with liver disorders.
COVID -19 is an infectious respiratory illness primarily spread through respiratory droplets from an infected person’s or carrier’s cough or sneeze, direct contact with the person, or touching a surface or object used by the person which could have the droplets.
Most infected individuals experience mild to moderate respiratory symptoms and recover within a few weeks. However, since the first cases of Covid-19 were reported, several clinical investigators have reported abnormal liver function tests in these patients.
The proportion of abnormal liver tests in COVID19 patients is steadily increasing and is currently reported to be as high as 50%. A recent study by Yale University found a strong link between abnormal liver tests and the poor prognosis of COVID 19. This included individuals who had normal liver function tests in their prior annual checks.
The derangement of liver enzymes like alanine aminotransferase (ALT) and aspartate aminotransferase (AST) during infection is not uncommon and does not indicate irreversible damage to the liver. The exact mechanism of liver injury during coronavirus infection remains unclear. However, the major contributors are not just the virus, but also the drugs used in COVID management and the body’s immune-mediated inflammatory response to the infection.
In light of the recent clinical developments, patients with advanced liver disease have been categorised as extremely vulnerable. This list includes patients with
About 40% of the patients who contract COVID-19 and prior advanced liver disease like cirrhosis have required hospitalization, intensive care, and had a poor prognosis including death.
The rate of death is higher in patients with liver disease and is reported to be around 3-4% worldwide as opposed to 1-2% in the general population with COVID-19.
The evidence might raise a lot of concerns in patients with liver disease. However, these results might not account for the asymptomatic and mild cases of COVID-19 who did not get tested. The data remains restricted to moderate and severe cases of COVID-19 that warranted a hospital admission and hence tested for liver injury. Those patients who stayed home and recovered from the disease are not a part of these reports.
Uncontrolled underlying diseases such as liver disorders can pose a greater risk during COVID 19 infection. Individuals with obesity and non-alcoholic fatty disease have a higher rate of metabolic risk factors such as hypertension and diabetes. These factors can aggravate the severity of the COVID-19 illness if they contract coronavirus.
Liver disease patients should continue the following as advised by their medical practitioner.
Patients with advanced liver disease should follow extra precautions to shield themselves from the infection despite the lifting of the lockdown restrictions. The guidelines for the vulnerable population include
With the advent of the pandemic, the Liver India team has shifted its priorities to focus on life-saving therapies, rescheduling elective procedures to minimize the risk of infection, and continuing routine care of patients with advanced liver disease via remote technology.
More than two-thirds of the liver disease visits have been transferred to telemedicine. Remote consultation has aided in limiting the exposure to COVID-19 during hospital visits for patients with end-stage liver disease, hepatic or hepatobiliary cancer, post-liver transplant patients, and those requiring urgent diagnostic tests and interventions.
Provisions of home nursing and home visits by laboratory services for blood draws etc., especially for the individuals who fall under the vulnerable category have enabled uninterrupted medical care.
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