Patients with cirrhosis during the COVID-19 pandemic: Current evidence and future perspectives
1Department of Emergency Medicine, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan.
Insights
Patients with cirrhosis face higher risks from coronavirus disease-2019 (COVID-19), experiencing increased morbidity and mortality. Continued standard cirrhosis care and preventive measures are crucial, while COVID-19 vaccine efficacy in this group requires further study.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Patients with cirrhosis have a dysregulated immune response, increasing susceptibility to viral infections like COVID-19.
- COVID-19 can cause liver injury in cirrhotic patients through direct viral effects, immune activation, drug toxicity, or hypoxia.
- Cirrhotic patients may present with atypical COVID-19 symptoms, including a lower incidence of gastrointestinal issues.
Purpose of the Study:
- To review the impact of COVID-19 on patients with cirrhosis.
- To highlight the increased risks of morbidity and mortality in cirrhotic patients with COVID-19.
- To discuss clinical manifestations, causes of liver injury, and management strategies for cirrhotic patients during the COVID-19 pandemic.
Main Methods:
- Literature review and synthesis of existing evidence on COVID-19 in cirrhosis.
- Analysis of clinical presentations, etiological factors of liver injury, and outcomes.
- Discussion of preventive measures, standard care, and palliative care considerations.
Main Results:
- Cirrhotic patients exhibit higher rates of morbidity and mortality from COVID-19 compared to the general population.
- Respiratory failure is a primary cause of death, though not always preceded by respiratory symptoms.
- Advanced cirrhosis is an independent predictor of poor prognosis in COVID-19 patients.
Conclusions:
- Cirrhotic patients are a vulnerable group requiring vigilant COVID-19 management and uninterrupted standard care.
- Palliative care should be considered for advanced cirrhosis patients with COVID-19.
- Further research is needed to determine the efficacy of COVID-19 vaccines in patients with cirrhosis.
Abstract:
The outbreak of coronavirus disease-2019 (COVID-19) has resulted in a global public health emergency. Patients with cirrhosis were deemed more susceptible to viral infection because of their dysregulated immune response. Similar to the general population, cirrhotic patients exhibit various degrees of COVID-19-related liver injury, which could be attributed to direct virus cytotoxicity, systemic immune system activation, drug-related liver injury, reactivation of pre-existing liver disease, and hypoxic hepatitis. The clinical symptoms in patients with cirrhosis and COVID-19 were similar to those in the general population with COVID-19, with a lower proportion of patients with gastrointestinal symptoms. Although respiratory failure is the predominant cause of mortality in cirrhotic patients with COVID-19, a significant proportion of them lack initial respiratory symptoms. Most evidence has shown that cirrhotic patients have relatively higher rates of morbidity and mortality associated with COVID-19. Advanced cirrhosis was also proposed as an independent factor affecting a poor prognosis and the need to consider COVID-19 palliative care. General measures implemented to prevent the transmission of the virus are also essential for cirrhotic patients, and they should also receive standard cirrhosis care with minimal interruptions. The efficacy of the available COVID-19 vaccines in cirrhotic patients still needs investigation.
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