Effect of COVID-19 on pre-existing liver disease: What Hepatologist should know?

Praveen, Sharma; Ashish, Kumar; Anikhindi, ShriHari Anil; Naresh, Bansal; Vikas, Singla; Khare, Shivam; Anil, Arora

COVID-19 is characterized by predominant respiratory and gastrointestinal symptoms. Liver enzymes derangement is seen in 15-55% of the patients. Advanced age, hypertension, diabetes, obesity, malignancy and, cardiovascular disease predispose them to severe disease and the need for hospitalization. Data on preexisting liver disease in patients with COVID -19 is limited and most studies had only 3-8% of these patients. Patients with metabolic dysfunction associated fatty liver (MAFLD) had shown 4-6 fold increase in severity of COVID-19 and its severity and mortality increased in patients with higher fibrosis score. Patients with chronic liver disease had shown that cirrhosis is an independent predictor of severity of COVID-19 with increased hospitalization and mortality. Increase in Child Turcotte Pugh (CTP) score and model for end-stage liver disease (MELD) score increases the mortality in these patients. Few case reports had shown SARS-CoV-2 as an acute event in the decompensation of underlying chronic liver disease. Immunosuppression should be reduced prophylactically in patients with autoimmune liver disease and post-transplantation with no COVID-19. Hydroxychloroquine and remdesivir is found to be safe in limited studies in a patient with cirrhosis and COVID-19. For hepatologist cirrhosis with COVID-19 is a pertinent issue as the present pandemic will have severe disease in patients with chronic liver disease leading to more hospitalisation and decompensation.