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©The Author(s) 2021.
World J Gastroenterol. Apr 7, 2021; 27(13): 1296-1310
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1296
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1296
Table 1 Prevalence of coronavirus disease 2019 patients with altered manifestations of hepatic injury markers
Salient findings | Country | Ref. |
Of 417 COVID-19 patients, 76.3% had altered values of liver function tests and 21.5% had liver injury during hospitalization. The use of lopinavir/ritonavir increased the risks of liver injury by 4-fold. | China | Cai et al[32], 2020 |
The prevalence of patients with GI symptoms and elevated level of liver enzymes was 18.6%. The severity of disease increased in patients with digestive symptoms. | China | Pan et al[81], 2020 |
Abnormal liver function tests are common in COVID-19 patients. Of 115 patients, 9.57% had increased ALT levels and 14.78% had increased AST levels. | China | Zhang et al[82], 2020 |
Liver dysfunction at an early stage increases the mortality risk in COVID-19 patients. A total of 151 patients (42.5%) were reported with cholestasis and 101 (28.5%) had hepatocellular injury. Liver dysfunction was more common in critically ill patients. | China | Fu et al[83], 2020 |
About 48.4% of patients with normal liver function had abnormal liver function tests after receiving lopinavir/ritonavir. Liver injury biomarkers (LDH, ALP, GGT, TBiL, prealbumin, and albumin) were dysregulated in a cohort of 288 COVID-19 patients, suggestive of potential as markers of liver injury and a prognosis of severe of COVID-19 disease. | China | Fan et al[37], 2020 and Fan et al[84], 2020 |
The presence of acute liver injury was linked with high risk of COVID-19 morbidities and admission to an ICU. | United States | Hajifathalian et al[85], 2020 |
Serum liver enzymes were increased in from 14% to 53% of hospitalized COVID-19 patients. | United States | Fix et al[68], 2020 |
Increased bilirubin level was seen in 16.7% and increased ALT and AST were seen in 15% of COVID-19 patients. | United States | Sultan et al[86], 2020 |
Table 2 Summary of specific European Association for the Study of the Liver, European Society of Clinical Microbiology and Infectious Diseases and American Association for the Study of Liver Diseases guidelines and recommendations for the clinical care and management of patients with liver diseases during coronavirus disease 2019 pandemic
Hospitalization and severe COVID-19 | Alterations to standard treatment strategies | Progression of liver disease | ||
Early administration, laboratory findings and risk of SARS-CoV-2 infection | Treatment of higher risk groups | Resumption of targeted treatment and surveillance | Patient education and intensive lifestyle advice | |
NAFLD | High prevalence risk of SARS-CoV-2 infection in NAFLD patients with COVID-19 suggest an early admission to the hospital | No side effects related to ACE inhibitors or AR blockers to date, thus, arterial hypertension treatment should continue in accordance to prescribed guidelines | Not well known | Intensive lifestyle interventions including nutritional guidance, weight loss and diabetes management may prevent the risk of severe COVID-19 complications |
Chronic Viral Hepatitis | Patients on chronic HBV or HCV medications with poor compliance should observed treatment protocols, directly | (1) In HBV and COVID-19 patients, an alternative agent should be considered rather than interferon-α therapy; (2) COVID-19 patients with high risk of severe acute HCV should consider for an appropriate antiviral therapy on case-by-case basis under the full consultation; and (3) COVID-19 patients with resolved HBV infection, receiving corticosteroids, tocilizumab, or other immunosuppressant agents should be considered for appropriate antiviral therapy to prevent viral reactivation under full consultation | (1) Without COVID-19, the patients should continue the HBV or HCV medications in accordance to general guidelines; and (2) in COVID-19 patients, initiation of HBV or HCV medication should be deferred until full recovery from COVID-19 or on case-by-case basis under the full consultation | Use of telemedicine for patients of on-going chronic HBV or HCV treatment without COVID-19 |
Autoimmune hepatitis | (1) Immunocompromised patients on corticosteroid treatment during COVID-19 requires respiratory support; And (2) patients on respiratory support may be considered for addition of, or conversion to, dexamethasone treatment | (1) Patients on high doses of corticosteroid may show more susceptibility to SARS-CoV-2 infection or severe COVID-19; (2) Low doses may be considered under special circumstances (e.g., drug-induced lymphopenia, or bacterial/fungal superinfection with severe COVID-19) under consultation with specialist; (3) or may consider budesonide as an alternative first line agent in patient without cirrhosis to induce remission who have a flare of autoimmune hepatitis | Immunocompromised patients with COVID-19 may be considered for dosing of corticosteroid, sufficient for adrenal insufficiency | All patients should receive vaccination of Streptococcus pneumoniae and influenza |
Alcohol-related liver hepatitis | Alcohol-induced severe hepatitis patients on corticosteroid treatment with COVID-19 require respiratory support | Not well known | Not well known | Increased probability of higher alcohol consumption during social distancing, so, preemptive strategies including patient outreach and telephone alcohol liaison, should be considered |
Cirrhosis | (1) Cirrhotic patients with COVID-19 should be considered for early hospitalization; and (2) to avoid admission and to prevent decompensation, guidelines on prophylaxis of spontaneous bacterial peritonitis, gastrointestinal hemorrhage and hepatic encephalopathy should be followed | Vasoconstriction therapy should be considered with great caution for critically ill cirrhotic patients with COVID-19 | Cirrhotic patients are vulnerable to both SARS-CoV-2 infection and altered standards of patient care during pandemic. Thus, the best efforts should be made for care of cirrhotic patients according to general guidelines | All patients should receive vaccination of Streptococcus pneumoniae and influenza |
Hepatocellular carcinoma | Specific risk of HCC patients with COVID-19 remains undefined | In COVID-19 patients, initiation of HBV or HCV medication should be deferred until full recovery from COVID-19 or on case-by-case basis under the full consultation | Full HCC surveillance should resume under specific circumstances | Consider virtual patient visits to discuss diagnosis and management of HCC and other liver tumors |
Liver transplant candidates | Patients on the liver transplant waiting list with decompensated cirrhosis are at high risk of severe COVID-19 and death following SARS-CoV-2 infection | Precautions should be followed to make COVID-19 free liver transplantation process | Not well known | Patients should avoid attending in-person community recovery support meetings, such as Alcoholics Anonymous, and provide alternative telephone or online resources |
Liver transplant recipients | Early admission should be considered for all liver transplant recipients who develop COVID-19 | Drug levels of calcineurin inhibitors and mechanistic target of rapamycin inhibitors should be closely monitored on administration with COVID-19 medications, particularly hydroxychloroquine, protease inhibitors or new trial drugs for COVID-19 | Reduction of immunosuppressant dosing may be considered under special circumstances (e.g., drug-induced lymphopenia, or bacterial/fungal superinfection with severe COVID-19) under consultation with specialist | All patients should receive vaccination of Streptococcus pneumoniae and influenza |
- Citation: Ahmad A, Ishtiaq SM, Khan JA, Aslam R, Ali S, Arshad MI. COVID-19 and comorbidities of hepatic diseases in a global perspective. World J Gastroenterol 2021; 27(13): 1296-1310
- URL: https://www.wjgnet.com/1007-9327/full/v27/i13/1296.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i13.1296