An international registry presented at the Digital International Liver Congress, revealed that COVID-19 in the presence of liver disease like non-alcoholic fatty liver disease or cirrhosis poses an increased risk for mortality and morbidity.

Experts have demonstrated a strong association between obesity and chronic liver disease with mortality during the pandemic. The most common form of chronic liver disease is non-alcoholic fatty liver disease (NAFLD). Epidemiological surveys suggest that up to 25% of the world’s population is affected with NAFLD and is significantly correlated to obesity, which is also considered as a risk factor for COVID-19. 

Evidence based observations show that the mortality rate increases upto nearly twofold if patient with COVID-19 is infected with NAFLD, this becomes an issue of great concern especially in younger adults of less than 60 years old. On the contrary, this association of increased death rate with NAFLD and COVID-19 cannot be seen in older patients.

The other findings of the registry of more than 1,000 patients with liver disease, demonstrated that non-cirrhotic liver disease did not exert an additional risk with COVID-19. However, once a patient developed cirrhosis, their risk increases, which is independent of age. Moreover, the proportion of patients who required ICU admission also increased along the course of liver disease severity.

The investigators reviewed submissions from 18 countries and reported on the largest cohort of LT recipients, which revealed that the mortality risk does not increase for patients with COVID-19 in the transplant setting. Additionally, these recipients did not show higher risk in contrast to non-transplant patients with similar comorbidities.  Therefore, when weighing the relative risk and benefits of delivering clinical follow up and monitoring of liver transplant patients, it should be taken into account that liver transplantation does not confer major additional susceptibility to adverse outcomes. On the contrary, other comorbidities such as age and renal function play an important role in the patients’ outcomes.

Besides transplant patients, considerations should be given to those who defer care due to fear of the pandemic. The innate fear of going to a hospital for routine screening may cause an increase in advanced liver disease, which further can cause a second wave of morbidity and mortality when infected with COVID-19. Thus, it is essential for physicians and patients to prioritize alternative methods of care to patients with chronic liver disease.

Source: Fatty liver, cirrhosis double mortality risk in COVID-19. Availabel at: https://www.healio.com/news/hepatology/20200828/fatty-liver-cirrhosis-double-mortality-risk-in-covid19  Accessed on: 04-06-2021.