‘Disturbing Finding’: Pandemic Delayed Care for Patients with Chronic Liver Disease

In a survey of patients with chronic liver disease from the United States and 6 other countries, 11.3% said the COVID-19 pandemic had a negative impact on their liver disease, with the majority reporting delays in follow-up care. Researchers published the findings online ahead of print in Hepatology Communications.

“This is a disturbing finding that, however, is in accordance with a recent study that reported a 40% reduction in the routine monitoring of chronic liver disease to include hepatocellular carcinoma surveillance during the pandemic,” wrote lead and corresponding author Zobair M. Younossi, MD, of the liver and obesity research program at Inova Medicine, Falls Church, Virginia, and coauthors. “It is important to note that the latter can lead to a rise in adverse and lethal outcomes, given that the doubling time for hepatocellular carcinoma tumor volume is less than 90 days.”

The study included 2500 patients with chronic liver disease from the Global Liver Registry. Participants from the United States, as well as Turkey, India, Egypt, Mexico, Malaysia, and Pakistan, completed a survey about their experience in the COVID-19 pandemic as of June 2021.

Among respondents, 9.3% reported having COVID-19: 86% were diagnosed by a laboratory test, 93% had at least one symptom, and 75% received treatment for symptoms—64% of whom received antiviral treatment, according to the study.

“Notably, 77% patients enrolled in Turkey and 80% in Pakistan reported having received antiviral treatment versus less than 10% in the United States,” the authors wrote. “This may reflect regional differences in COVID-19 management or changes in treatment over time occurring along with local surges of infections in specific geographic areas.”

Of respondents who experienced COVID-19, 19% were hospitalized, and 13% needed oxygen support. None, however, required mechanical ventilation. Patients with a COVID-19 history scored lower on a self-assessed health score scale despite reporting similar health scores if there was no pandemic, researchers reported. After adjustment for factors including country, liver disease etiology and severity, age, sex, body mass index, diabetes, and history of psychiatric comorbidities, having had COVID-19 was independently associated with lower self-assessed health scores.

Regardless of their personal COVID-19 history, 11.3% of respondents overall said the pandemic had a negative impact on their liver disease. Nearly three-quarters of them cited delays in follow-up care.

“Given that timely access to both routine and urgent health care is essential for patients with chronic liver disease, policymaker efforts must focus on how to effectively continue to deliver care even during a public health emergency,” researchers advised.

—Jolynn Tumolo

Reference:
Younossi ZM, Yilmaz Y, El-Kassas M, et al. The impact of the COVID-19 pandemic on patients with chronic liver disease: results from the Global Liver Registry. Hepatol Commun. Published online ahead of print July 26, 2022.