COVID-19: how does it affect the liver and liver disease patients?

COVID-19 has shown the potential to affect every system in the body, including the liver. If you or someone you know has liver disease, you may be worried about how COVID-19 can affect treatment and general health. Professor Kevin Moore provides you with what experts currently know regarding COVID-19 and liver disease.

How does COVID-19 affect the body?

The novel coronavirus COVID-19 is not a simple respiratory tract infection: it affects every single system in the body, including the liver. The main symptoms of COVID-19 are cough and fever. Other symptoms, which older people are more likely to experience, are muscle aches and severe fatigue. However, younger people may only experience a slight cough and a temporary loss of taste or smell.

Not only does COVID-19 raise the risk of respiratory infections but it also raises the risk of pulmonary embolism, gastrointestinal disturbances and diabetic insulin control. It also increases the risk of acute kidney injury (AKI) with the need for renal support dialysis. Furthermore, it can cause abnormal liver function.

Are people with liver disease in the vulnerable category for COVID-19?

• People with significant liver disease (cirrhosis) are considered immune-compromised and therefore high risk.
• People with mild liver disease (fatty liver disease but no cirrhosis) would not be considered as part of the high-risk category.

Having said that, fatty liver disease is related to higher instances of hypertension (high blood pressure), obesity and diabetes. These conditions are high-risk factors for hospitalisation and mortality from the COVID-19 infection.

Are patients with liver disease at a higher risk of having severe symptoms?

There is a liver registry being developed in Europe to track liver disease and its effect on COVID-19 patients. Until more data is gathered, it is difficult to say. With the information gathered so far, we believe that patients with cirrhosis have a higher mortality rate than the average admitted patient. We also believe patients with cirrhosis to have more severe consequences if they develop a bacterial infection during their COVID-19 illness.

Does COVID-19 affect the liver?

We know that between 60-70% of patients with the COVID-19 infection have an abnormal liver function on admission to hospital. 1-2% of patients have severely abnormal liver function. Often, many of the tests we do are misnomers: a liver function test examines if the liver is injured more than its function. A liver function test is performed by testing the blood and detecting is specific enzymes or proteins are too high. These results determine if the liver’s condition is deteriorating.

It’s important to note, however, that the mechanism by which COVID-19 affects the liver is poorly understood at present. We can’t understand it further until more time has passed.

Does COVID-19 make liver disease worse?

If you have cirrhosis, COVID-19 may cause acute on chronic liver failure, which is a sudden deterioration of an already diagnosed liver disease.

Should liver disease patients continue taking their medication?

Yes, keep taking medication as prescribed. Patients who are taking immunosuppressive medication, such as liver transplant patients, should also continue taking their medication. It is possible that medication for liver conditions reduces the risk of clearing the virus quickly, but we still can’t know yet. If your specialist hasn’t been in contact so far and you are concerned, consult with them first before making any changes to your medication.

What happens to postponed hospital treatments for liver disease?

At the moment, everything has been put back. For many patients who have been referred for investigation, they can be assured that liver disease usually develops over a long time. Fatty liver disease might develop over 15-20 years, for example. A delay of a few months for people in this group is very likely of little consequence. For patients with chronic viral hepatitis, a few months will likely not make a difference to treatment outcomes.

For those with established cirrhosis, it is still necessary to be screened for liver cancer. Generally speaking, there’s a 2% risk of developing liver cancer from cirrhosis each year. Patients with liver disease that’s evolving, such as autoimmune liver disease or acute liver disease, need to be seen and treated urgently as these conditions can lead to liver failure.

Professor Moore is one of London’s leading and most reputable liver specialists. Don’t hesitate to get in touch with him by clicking here.