Chronic liver disease can add to risk of death in COVID-19 patients, says doctors at Regency Super specialty Hospital, Lucknow

Dr Praveen Jha

Lucknow, September 07, 2020: Doctors at the Regency Superspeciality Hospital, Lucknow have warned the residents of Uttar Pradesh, which is witnessing a sudden rise in coronavirus cases in last one month, to be extra cautious if they have any chronic liver disease such as hepatitis B, hepatitis C, fatty liver or cirrhosis because they have the greater risk than other individuals for severe COVID-19 and the occurrence of complications including prolonged hospital stay and mortality.

According to a recent study by Asia Pacific COVID-19, Liver Injury Spectrum conducted across 13 countries, including India has found out that 43 per cent of those who were in the advanced stages of the disease with cirrhosis or scarring due to the ailments died of Covid-19. This is much higher than the 3 to 5% mortality rate in the general population.

“As a result of lockdowns and suspension of usual clinical care activities for the benefit of patients with COVID-19, the pandemic is having a major effect on the management of patients with chronic liver diseases, in particular those with cirrhosis, hepatocellular carcinoma and in liver transplantation programmes. The potential onset of COVID-19 in these patients (with chronic liver disease) raises two questions: will patients with chronic liver disease develop a more severe form of COVID-19; and will COVID-19 aggravate the course of their liver disease and induce liver-related mortality. Patients with cirrhosis seem to be at greater risk than other individuals for severe COVID-19 and the occurrence of complications, including mortality, regardless of the aetiology of liver disease. If these patients have associated metabolic comorbidities that include obesity, diabetes and hypertension, then they are at higher risk of developing severe COVID-19,” said Dr Praveen Jha, MD, DM, Consultant Gastroenterology, Regency Superspeciality Hospital, Lucknow.

Therefore, it is very important to monitor liver enzymes in Covid-19 patients. This is especially true because the liver is the only organ that can regenerate after an injury, so patients do not show symptoms of a liver disease till the liver is about 80% damaged. It has been observed that during the COVID-19 crisis, attention has been diverted from chronic viral hepatitis, despite the fact that global mortality attributed to viral hepatitis, which has been estimated by the WHO Global Hepatitis Report 2017 to be approximately 1.5 million per year, currently remains higher than that from COVID-19, while resources for public health interventions are already shrinking. The doctor feels the greatest effect of COVID-19 on liver-related morbidity and mortality remains to come.

“The global economic crisis has already begun. Bankruptcies, job losses, money and food shortage, social isolation and family issues will lead to increases in alcohol and drug use, whereas access to care will suffer from the collapse of health-care structures and organizations, and from government policies diverting resources elsewhere. This situation could translate into a substantial increase in blood-borne virus transmissions as well as in alcoholic liver disorders and decompensations, resulting in many more patients with cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death. These unforeseen effects of the COVID-19 pandemic will take years to become visible, but they are inevitable,” Dr Praveen Jha, MD, DM, Consultant Gastroenterology, Regency Superspeciality Hospital added.

The patients of chronic liver diseases must not ignore their health during this time and adhere to the guidelines given by the government and WHO. For regular treatment, patients can consult their doctors through telemedicine and must visit the hospital if any emergency arises.