Korean J Gastroenterol.  2021 Apr;77(4):156-159. 10.4166/kjg.2021.402.

Management of Patients with Chronic Liver Disease: The Era of the COVID-19 Pandemic

  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea


Pandemic of coronavirus disease 2019 (COVID-19) has caused many changes in the healthcare system and patients with preexisting advanced liver disease, notably cirrhosis, are associated with a severe course and a high mortality rate of COVID-19. In patients with liver disease, the underlying liver disease severity is closely related to the prognosis, so appropriate management of liver disease will be one of the most important strategies to protect the patient from COVID-19 infection that may occur in the future. The approach to patient care should be individualized and flexible according to the type and severity of patient’s underlying liver disease, the prevalence of COVID-19, and availability of medical resource. If possible, standard of care for patients with liver disease should be resumed In addition, it is necessary to predict and prepare for the wave of liver disease yet to come after the COVID-19 pandemic.


Liver diseases; Liver cirrhosis; Management; COVID-19


1. Yang J, Zheng Y, Gou X, et al. 2020; Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 94:91–95. DOI: 10.1016/j.ijid.2020.03.017. PMID: 32173574. PMCID: PMC7194638.
2. Marjot T, Moon AM, Cook JA, et al. 2021; Outcomes following SARSCoV-2 infection in patients with chronic liver disease: an international registry study. J Hepatol. 74:567–577. DOI: 10.1016/j.jhep.2020.09.024. PMID: 33035628. PMCID: PMC7536538.
3. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. 2019; Burden of liver diseases in the world. J Hepatol. 70:151–171. DOI: 10.1016/j.jhep.2018.09.014. PMID: 30266282.
4. Albillos A, Lario M, Álvarez-Mon M. 2014; Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol. 61:1385–1396. DOI: 10.1016/j.jhep.2014.08.010. PMID: 25135860.
5. Mao R, Qiu Y, He JS, et al. 2020; Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 5:667–678. DOI: 10.1016/S2468-1253(20)30126-6.
6. Wang Y, Liu S, Liu H, et al. 2020; SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. J Hepatol. 73:807–816. DOI: 10.1016/j.jhep.2020.05.002. PMID: 32437830. PMCID: PMC7211738.
7. Fix OK, Hameed B, Fontana RJ, et al. 2020; Clinical best practice advice for hepatology and liver transplant providers during the COVID-19 pandemic: AASLD Expert Panel Consensus Statement. Hepatology. 72:287–304. DOI: 10.1002/hep.31281. PMID: 32298473. PMCID: PMC7262242.
8. Mahmud N, Hubbard RA, Kaplan DE, Serper M. 2020; Declining cirrhosis hospitalizations in the wake of the COVID-19 pandemic: a national cohort study. Gastroenterology. 159:1134–1136.e3. DOI: 10.1053/j.gastro.2020.05.005. PMID: 32387493. PMCID: PMC7200325.
9. Boettler T, Newsome PN, Mondelli MU, et al. 2020; Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep. 2:100113. DOI: 10.1016/j.jhepr.2020.100113. PMID: 32289115. PMCID: PMC7128473.
10. Cho JY, Kim SS, Lee YS, Song DS, Lee JH, Kim JH. 2020; Management of liver diseases during the pandemic of coronavirus disease-19. Clin Mol Hepatol. 26:243–250. DOI: 10.3350/cmh.2020.0111. PMID: 32570302. PMCID: PMC7364349.
11. Ji D, Qin E, Xu J, et al. 2020; Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. J Hepatol. 73:451–453. DOI: 10.1016/j.jhep.2020.03.044. PMID: 32278005. PMCID: PMC7141624.
12. Iavarone M, D'Ambrosio R, Soria A, et al. 2020; High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol. 73:1063–1071. DOI: 10.1016/j.jhep.2020.06.001. PMID: 32526252. PMCID: PMC7280108.
13. Crews FT, Bechara R, Brown LA, et al. 2006; Cytokines and alcohol. Alcohol Clin Exp Res. 30:720–730. DOI: 10.1111/j.1530-0277.2006.00084.x. PMID: 16573591.
14. Kim D, Adeniji N, Latt N, et al. 2020; Sep. 17. Predictors of outcomes of COVID-19 in patients with chronic liver disease: US multi-center study. Clin Gastroenterol Hepatol. [Epub ahead of print]. DOI: 10.1016/j.cgh.2020.09.027.
15. Bajaj JS, Garcia-Tsao G, Biggins SW, et al. 2021; Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Gut. 70:531–536. DOI: 10.1136/gutjnl-2020-322118. PMID: 32660964. PMCID: PMC7371484.
16. Lee YR, Kang MK, Song JE, et al. 2020; Clinical outcomes of coronavirus disease 2019 in patients with pre-existing liver diseases: a multicenter study in South Korea. Clin Mol Hepatol. 26:562–576. DOI: 10.3350/cmh.2020.0126. PMID: 33053932. PMCID: PMC7641571.
17. Qi X, Liu Y, Wang J, et al. 2021; Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: a multicentre cohort study. Gut. 70:433–436. DOI: 10.1136/gutjnl-2020-321666. PMID: 32434831. PMCID: PMC7815629.
18. Webb GJ, Moon AM, Barnes E, Barritt AS, Marjot T. 2020; Determining risk factors for mortality in liver transplant patients with COVID-19. Lancet Gastroenterol Hepatol. 5:643–644. DOI: 10.1016/S2468-1253(20)30125-4.
19. Wang Y, Zhang D, Du G, et al. 2020; Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 395:1569–1578. DOI: 10.1016/S0140-6736(20)31022-9.
Full Text Links
  • KJG
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr