Patients with liver disease and COVID report additional difficulties

The COVID-19 pandemic has had a dramatic impact on the daily lives of patients with chronic liver disease, according to a global cross-sectional study.

Among 2,500 patients with chronic liver disease, 11.3% said the pandemic had negatively impacted their disease, which was mainly due to delays in follow-up care (73%), reported Zobair Younossi, MD, MPH, of Inova Medicine in Falls Church, Virginia and colleagues, writing in Communications Hepatology.

More patients with COVID-19 than without COVID-19, respectively, reported having a worse social life and worsening exercise habits and financial stability (P

  • Social life: 74% vs 61%
  • Exercise: 51% versus 42%
  • Financial stability: 37% versus 30%

COVID-19 was independently associated with lower self-reported health scores after adjusting for sex, age, BMI, diabetes, country, etiology/severity of liver disease and psychiatric comorbidities (beta = -0.71 on a scale of 1 to 10, P

Younossi’s group noted that reductions in follow-up care including screening for hepatocellular carcinoma (HCC) “may result in increased adverse and fatal outcomes given that the tumor volume doubling time of HCC is less than 90 days”.

“Furthermore, delayed care has been shown to increase liver-related mortality even without developing HCC,” they continued. “These findings could help policy makers plan for future public health emergencies when determining how to keep access to healthcare open to all while dealing with the emergency rather than trading one disease for another. .”

David Bernstein, MD, of the Feinstein Institutes for Medical Research/Northwell Health in Manhasset, New York, said MedPage todaythat patients with more severe liver disease appear to be disproportionately affected by COVID-19.

For their study, the researchers looked at data from the Global Liver Registry on patients with chronic liver disease who responded to a COVID-19 survey in June 2021 in seven countries, including Turkey (59% of respondents). , the United States (16%) and Egypt (11%), among others. Two-thirds of patients had nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, while 20% had chronic liver disease related to hepatitis B and 14% to hepatitis C. Patients with decompensated cirrhosis and cancer liver were excluded, as were those who underwent liver transplantation.

The mean age of the patients was 49 years old and 53% were men. Nearly 40% reported overt fatigue, 37% had type 2 diabetes, and 30% reported an anxiety/panic disorder.

Overall, 9.3% of patients had COVID-19. Of these, 19% were hospitalized and 13% received oxygen support. No patient required mechanical ventilation. Almost all had one or more symptoms (93%). Three quarters were treated for their symptoms, mainly with antiviral agents (64%). The average duration of illness was 12.5 days.

The authors found that patients from Mexico (2% of respondents) and Pakistan (5%) said their liver disease was most affected by the pandemic (38%), mainly due to limited access to routine care, and that these patients needed the most specialized care.

Significantly more people with COVID-19 experienced worsening of at least one lifestyle factor – social life, exercise, diet/nutrition, education, financial issues, health care or housing – compared to those without. COVID-19 (81% vs. 69% , P=0.0001).

Those with a history of COVID-19 also had poorer self-rated health (Likert health score 6.7 versus 7.4 out of 10, PP=0.59), according to the authors.

Limitations of the study included that the results can only apply to people who responded to the survey and not to all patients with chronic liver disease. Moreover, only a few countries were included with a small number of sites. Finally, the study did not assess the severity of the disease, the different variants or the periods of availability of the vaccine.

  • Zaina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.


Younossi disclosed relationships with Gilead, Intercept and Merck. A co-author revealed relationships with AbbVie, Abdi Ibrahim, Bimillah Pharmaceutical, Biocodex, Echosens, Gilead, and Novo Nordisk.

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