WGO Guidance for the Care of Patients With COVID-19 and Liver Disease

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Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as “bystander hepatitis,” myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19—such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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A pneumonia outbreak associated with a new coronavirus of probable bat origin

Peng Zhou, Xing-Lou Yang, Xian-Guang Wang … (2020)

Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.

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Cancer statistics, 2019

Rebecca Siegel, Kimberly D Miller, Ahmedin Jemal (2019)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.

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Author and article information

Contributors

Cihan Yurdaydin

Journal

Journal ID (nlm-ta): J Clin Gastroenterol

Journal ID (iso-abbrev): J Clin Gastroenterol

Journal ID (publisher-id): MCG

Title: Journal of Clinical Gastroenterology

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 0192-0790

ISSN (Electronic): 1539-2031

Publication date (Print): January 2021

Publication date (Electronic): 20 November 2020

Volume: 55

Issue: 1

Pages: 1-11

Affiliations

[* ]Department of Medicine, Aga Khan University, Karachi, Pakistan

[† ]GI/Liver Unit, Hospital de Clínicas de Porto Alegre, University of Sao Paulo, Porto Alegre, Brazil

[‡ ]Department of Medicine and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB

[## ]Division of Gastroenterology, McMaster University Medical Centre, Hamilton, ON, Canada

[§ ]Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

[∥ ]Department of Gastroenterology and Hepatology, Radboud UMC, Nijmegen, The Netherlands

[¶ ]Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

[# ]Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal

[** ]Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA

[†† ]Hepatitis Program, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia

[‡‡ ]Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK

[§§ ]Section of Hepatology, Rush University Medical Center, Chicago, IL

[∥∥ ]Department of Medicine, Division of Hepatology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

[¶¶ ]Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH

[*** ]Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey

Author notes

Address correspondence to: Cihan Yurdaydin, MD, Department of Gastroenterology and Hepatology, Koç University Medical School, Topkapi, Davutpasa Cad. No: 4 34010 Zeytinburnu, Istanbul, Turkey (e-mail: cyurdaydin@ 123456ku.edu.tr ).

Article

Accession ID: 00003

DOI: 10.1097/MCG.0000000000001459

PMC ID: 7713641

PubMed ID: 33230011

SO-VID: e4b1deb4-7604-44b8-bbec-c8dc42f68d79

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This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

History

Date received : 5 August 2020

Date accepted : 11 August 2020

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Keywords: covid-19 disease,liver disease,chronic viral hepatitis,metabolic dysfunction-associated liver disease,autoimmune liver diseases,hepatocellular carcinoma,liver transplantation

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Keywords: covid-19 disease, liver disease, chronic viral hepatitis, metabolic dysfunction-associated liver disease, autoimmune liver diseases, hepatocellular carcinoma, liver transplantation

WGO Guidance for the Care of Patients With COVID-19 and Liver Disease

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Novel Coronavirus Disease COVID-19

Most cited references 75

Clinical Characteristics of Coronavirus Disease 2019 in China

A pneumonia outbreak associated with a new coronavirus of probable bat origin

Cancer statistics, 2019

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