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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2021; 9(13): 2951-2968
Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.2951
Patients with cirrhosis during the COVID-19 pandemic: Current evidence and future perspectives
Hung-Yuan Su, Yin-Chou Hsu
Hung-Yuan Su, Yin-Chou Hsu, Department of Emergency Medicine, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Hung-Yuan Su, Yin-Chou Hsu, School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung 82445, Taiwan
Author contributions: Hsu YC designed the study; Su HY and Hsu YC reviewed the literature and drafted the manuscript; both authors have read and approved the final manuscript.
Conflict-of-interest statement: Authors have nothing to declare.
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: Hsu YC, MD, Staff Physician, Department of Emergency Medicine, E-DA Hospital, I-Shou University, No. 1 Yida Road, Jiao-su Village, Yanchao District, Kaohsiung 82445, Taiwan. yinchou0406@gmail.com
Received: January 4, 2021
Peer-review started: January 4, 2021
First decision: January 23, 2021
Revised: February 5, 2021
Accepted: March 25, 2021
Article in press: March 25, 2021
Published online: May 6, 2021
Abstract

The outbreak of coronavirus disease-2019 (COVID-19) has resulted in a global public health emergency. Patients with cirrhosis were deemed more susceptible to viral infection because of their dysregulated immune response. Similar to the general population, cirrhotic patients exhibit various degrees of COVID-19-related liver injury, which could be attributed to direct virus cytotoxicity, systemic immune system activation, drug-related liver injury, reactivation of pre-existing liver disease, and hypoxic hepatitis. The clinical symptoms in patients with cirrhosis and COVID-19 were similar to those in the general population with COVID-19, with a lower proportion of patients with gastrointestinal symptoms. Although respiratory failure is the predominant cause of mortality in cirrhotic patients with COVID-19, a significant proportion of them lack initial respiratory symptoms. Most evidence has shown that cirrhotic patients have relatively higher rates of morbidity and mortality associated with COVID-19. Advanced cirrhosis was also proposed as an independent factor affecting a poor prognosis and the need to consider COVID-19 palliative care. General measures implemented to prevent the transmission of the virus are also essential for cirrhotic patients, and they should also receive standard cirrhosis care with minimal interruptions. The efficacy of the available COVID-19 vaccines in cirrhotic patients still needs investigation.

Keywords: COVID-19, SARS-CoV-2, Cirrhosis, Acute liver injury, Prognosis, Therapy

Core Tip: Several studies have addressed the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cirrhosis. The presence and stage of cirrhosis is correlated with the development of severe coronavirus disease-2019 (COVID-19), COVID-19-related adverse outcomes, and mortality. It remains unclear whether SARS-CoV-2 infection is a trigger of acute decompensation or acute-on-chronic liver failure in cirrhotic patients based on the current evidence. There is still no clearly proven effective pharmacological treatment for cirrhotic patients with COVID-19. Clinicians should maintain standard cirrhosis care, defer unnecessary liver-specific procedures and have a low threshold for admission if cirrhotic patients are infected with SARS-CoV-2.