Preexisting Liver Disease Tied to Higher COVID-19 Risks

By David Douglas

May 18, 2020

NEW YORK (Reuters Health) — Patients who already have liver disease are at greater peril of untoward consequences than other COVID-19 patients, according to new research.

"Expression of receptors for COVID-19 has been suggested in the liver and liver injury is possible during the COVID-19 disease progression," Dr. Shailendra Singh of Charleston Area Medical Center Health System, in Charleston, West Virginia, told Reuters Health by email. "Patients with liver disease might be at increased risk of COVID-19 poor outcomes."

To investigate, Dr. Singh and Dr. Ahmad Khan mined electronic medical records of more than 49 million patients in the U.S. They identified a total of 2,780 COVID-19 patients, of whom 250 (9%) had pre-existing liver disease, including 50 (1.8%) with cirrhosis.

Patients in the liver-disease group had a higher risk of mortality (relative risk, 2.8; P<0.001). The risk remained significantly raised after propensity matching (RR, 3.0), the researchers report in Gastroenterology.

The patients with cirrhosis had an even higher relative risk of mortality compared with those without liver disease (RR, 4.6). Liver patients also had substantially higher comorbidities, and a large proportion had hypertension (68%) and diabetes (48%).

"Physicians should evaluate the COVID-19 patients for pre-existing liver disease in addition to other high-risk comorbidities to risk stratify these patients," said Dr. Singh. "Because of this risk especially patients with cirrhosis need strict isolation or social distancing, intensive surveillance, and timely diagnosis."

Dr. Priya Grewal of Mount Sinai Medical Center, in New York City, who specializes in liver medicine, told Reuters Health by email, "While NASH (non-alcoholic steatohepatitis) patients tend to have co-morbidities such as diabetes, hypertension and cardiovascular disease which independently increase risk of mortality from COVID -19, this effect persisted even after controlling for these conditions."

"As such," she said, "patients with chronic liver disease should be considered a vulnerable population in context of the COVID-19 pandemic."

SOURCE: Gastroenterology, online May 3, 2020.