Patients With Liver Disease and COVID Report Extra Hardships

The COVID-19 pandemic substantially impacted the daily lives of patients with chronic liver disease, a global cross-sectional study found.

Among 2,500 chronic liver disease patients, 11.3% reported that the pandemic had negatively impacted their disease, which was mostly due to delays in follow-up care (73%), reported Zobair Younossi, MD, MPH, of Inova Medicine in Falls Church, Virginia, and colleagues, writing in Hepatology Communications.

More patients with COVID-19 versus without COVID-19, respectively, reported having a worse social life and that their exercise habits and financial stability got worse (P<0.025 for all):

• Social life: 74% vs 61%
• Exercise: 51% vs 42%
• Financial stability: 37% vs 30%

COVID-19 was independently associated with lower self-reported health scores after adjusting for sex, age, BMI, diabetes, country, liver disease etiology/severity, and psychiatric comorbidities (beta = -0.71 on a 1 to 10 scale, P<0.0001), according to the authors.

Younossi’s group noted that reductions in follow-up care, including hepatocellular carcinoma (HCC) screening “can lead to a rise in adverse and lethal outcomes given that the doubling time for HCC tumor volume is less than 90 days.”

“In addition, delayed care has been shown to increase liver-related mortality even without developing HCC,” they continued. “These findings could help policy makers plan for future public health emergencies when determining how to keep access to health care open for all while also dealing with the emergency rather than trading one disease for another.”

David Bernstein, MD, of the Feinstein Institutes for Medical Research/Northwell Health in Manhasset, New York, told MedPage Today, that patients with more severe liver disease appear to be disproportionately affected by COVID-19.

For their study, the researchers examined global liver registry data on chronic liver disease patients who completed a COVID-19 survey in June 2021 across seven countries, including Turkey (59% of respondents), the U.S. (16%), and Egypt (11%), among others. Two-thirds of patients had non-alcoholic fatty liver disease or non-alcoholic steatohepatitis, while 20% had chronic liver disease stemming from hepatitis B, and 14% from hepatitis C. Patients with decompensated cirrhosis and liver cancer were excluded, as were those who underwent liver transplantation.

Mean patient age was 49 and 53% were men. Nearly 40% reported overt fatigue, 37% had type 2 diabetes, and 30% reported anxiety/panic disorder.

Overall, 9.3% of patients had COVID-19. Of those, 19% were hospitalized and 13% received oxygen support. No patients required mechanical ventilation. Nearly all had one symptom or more (93%). Three-quarters were treated for their symptoms, mostly with antiviral agents (64%). Mean illness duration was 12.5 days.

The authors found that patients from Mexico (2% of respondents) and Pakistan (5%) reported their liver disease was impacted the most by the pandemic (38%), mainly because of limited access to routine care, and that these patients required the most specialized care.

Significantly more of those with COVID-19 experienced worsening in at least one lifestyle factor — social life, exercise, food/nutrition, education, financial matters, healthcare or housing — compared to those without COVID-19 (81% vs 69%, P=0.0001).

Those with a history of COVID-19 also had worse self-assessed health (Likert health score 6.7 vs 7.4 out of 10, P<0.0001), even though they reported similar health scores if there had been no pandemic (8.5 vs 8.4, P=0.59), according to the authors.

Study limitations included the fact that the findings may only apply to those who responded to the survey and not to all patients with chronic liver disease. Also, only a few countries were included with a small number of sites. Finally, the study did not assess disease severity, different variants, or time periods of vaccine availability.