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World J Gastroenterol. Sep 28, 2021; 27(36): 6039-6052
Published online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.6039
Liver disease in the era of COVID-19: Is the worst yet to come?
Ivana Mikolasevic, Dorotea Bozic, Tajana Pavić, Alen Ruzic, Goran Hauser, Marija Radic, Delfa Radic-Kristo, Melanija Razov-Radas, Zeljko Puljiz, Sandra Milic
Ivana Mikolasevic, Goran Hauser, Sandra Milic, Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
Ivana Mikolasevic, Department of Gastroenterology, University Hospital Merkur, Zagreb 10000, Croatia
Ivana Mikolasevic, Alen Ruzic, Goran Hauser, Sandra Milic, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
Dorotea Bozic, Zeljko Puljiz, Department for Gastroenterology and Hepatology, University Hospital Center Split, Split 21000, Croatia
Tajana Pavić, Department of Gastroenterology and Hepatology, Faculty of Medicine, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia
Alen Ruzic, Clinic for Cardiology, University Hospital Center Rijeka, Rijeka 51000, Croatia
Goran Hauser, Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
Marija Radic, Delfa Radic-Kristo, Faculty of Medicine, Zagreb 10000, Croatia
Delfa Radic-Kristo, Department of Hematology, University Hospital Merkur, Zagreb 10000, Croatia
Melanija Razov-Radas, Division of Gastroenterology, General Hospital Zadar, Zadar 23000, Croatia
Zeljko Puljiz, University of Split, School of Medicine, Split 21000, Croatia
Author contributions: Mikolasevic I researched the database, wrote the manuscript and is the guarantor of this work; Bozic D, Pavić T, Ruzic A, Hauser G, Milic S, Radic M, Radic-Kristo D, Razov-Radas M and Puljiz Z contributed to the discussion and reviewed/edited the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ivana Mikolasevic, PhD, Professor, Department of Gastroenterology, Clinical Hospital Center Rijeka, Kresimirova 42, Rijeka 51000, Croatia. ivana.mikolasevic@gmail.com
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: July 3, 2021
Revised: July 18, 2021
Accepted: September 1, 2021
Article in press: September 1, 2021
Published online: September 28, 2021
Processing time: 206 Days and 9.2 Hours
Abstract

The global social, economic and political crises related to coronavirus disease 2019 (COVID-19) presumably had more indirect than direct negative impacts on health systems. Drastic lifestyle changes, social isolation and distancing, and individual and global financial crises resulted in robust populations forfeiting healthy habits and seeking comfort in alcoholic beverages, drugs and unhealthy diets. The inevitable consequences are increases in the incidence of nonalcoholic fatty liver disease, viral hepatitis, acute alcoholic hepatitis, liver cirrhosis decompensation and ultimately liver-related mortality. The inaccessibility of regular clinical and sonographic monitoring systems has caused difficulties in the treatment of patients with chronic liver disease (CLD) and has prevented prompt hepatocellular carcinoma detection and treatment. A dramatic reduction in the number of liver donors and the transformation of numerous transplantation centers into COVID-19 units drastically decreased the rate of orthotopic liver transplantation. The indirect, unavoidable effects of the COVID-19 pandemic in the following years have yet to be determined. Substantial efforts in the management of patients with liver disease in order to overcome the inevitable COVID-19-related morbidity and mortality that will follow have yet to be initiated. Several questions regarding the impact of the COVID-19 pandemic on liver disease remain. The most important question for general CLD patients is: How will the modification of clinical practice during this pandemic affect the outcomes of CLD patients? This article reviews the influence of COVID-19 on patients with liver disease during the pandemic, with particular emphasis on the disease course associated with pandemic resolution.

Keywords: COVID-19; Pandemic; Chronic liver disease; Management; Impact; Liver-related mortality

Core Tip: The global social, economic and political crises related to coronavirus disease 2019 (COVID-19) presumably cause more indirect than direct negative impacts on the health system. Drastic lifestyle changes, social isolation and distancing, and individual and global financial crises resulted in a robust population forfeiting healthy habits and seeking comfort in alcoholic beverages, drugs and unhealthy diets. The inevitable consequence is the increasing incidence of liver disease, liver cirrhosis decompensation and ultimately liver-related mortality. The indirect unavoidable effects of the COVID-19 pandemic in the following years have yet to be determined.