Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic

Abstract

During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. While some healthcare systems are returning to a more normal routine, many countries and healthcare systems have been, or still are, overwhelmed by the pandemic, which is significantly impacting on the care of these patients. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the disease course must be kept in mind when caring for patients with COVID-19. This review should serve as an update on the previous position paper, summarising the evidence for liver disease involvement during COVID-19 and providing recommendations on how to return to routine care wherever possible.

Keywords: ACE2, angiotensin-converting enzyme 2; ACLF, acute-on-chronic liver failure; COVID-19; COVID-19, coronavirus disease 2019; Cancer; Cirrhosis; ERC, endoscopic retrograde cholangiography; HCC, hepatocellular carcinoma; IL-6, interleukin-6; LT, liver transplant; Liver; MELD, model for end-stage liver disease; NAFLD; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; OGD, oesophagogastroduodenoscopy; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Telemedicine; Transplantation; ULN, upper limit of normal.

Fig. 1

Liver disease progression and poor outcomes from severe acute respiratory syndrome coronavirus 2 infection are closely associated. There must therefore be a concerted effort to resume standard of care and restore hepatology/transplantation services in order to improve patient outcomes.

Fig. 2

Summary of recommendations. ACLF, acute-on-chronic liver failure; COVID-19, coronavirus disease 2019; HCC, hepatocellular carcinoma; LT, liver transplant; MELD, model for end-stage liver disease; NASH, non-alcoholic steatohepatitis; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.