Liver Disease Patients Not at Increased Risk of COVID-19 Adverse Outcomes

Robert S. Brown, MD

As clinicians and investigators in every specialty is examining the specific impact of the novel coronavirus (COVID-19), initial data suggests the liver is faring well and patients with liver disease are not at an increased risk of adverse outcomes.

In an interview with HCPLive®, Robert S. Brown, MD, Weill Cornell Medicine and member of the American Liver Foundation's National Medical Advisory Committee, said it is unlikely COVID-19 results in much worse liver outcomes for patients.

“Liver manifestations haven't been a major problem, not that liver enzyme elevations are not uncommon because they are, but severe liver injury, liver failure, symptomatic acute hepatitis or liver inflammation do not seem to be a major issue,” Brown said. “What that means for the general public is certainly they're safe from the liver perspective and what it means I think for patients with mild-to-moderate liver disease is there probably safe.”

Brown said less is known about patients with severe liver issues and those on the liver transplant list as to whether they are at a higher risk for more adverse outcomes should they contract the virus.

“We’re cautious with that group of patients, as we are with our post-liver transplant patients,” Brown said, adding that thus far there has not been many additional issues for liver transplant recipients.

“Now, whether that's because our transplant patients are being extra careful or they are not at increased risk of consequence still remains to be determined, but my approach is obviously everyone at this time should be exhibiting social distancing.”

Individuals who contract the virus do exhibit a small amount of liver inflammation, but not enough to irritate the average person, or even someone with mild-to-moderate liver disease.

Brown added the patients with severe liver inflammation tend to be the older patients with multi-system failures. He also said liver disease patients are not at an increased risk of contracting the disease, but should still exhibit extreme caution as the disease is very contagious.

One of the more recent trends is more and more younger people are contracting COVID-19. Brown said an explanation for this is that younger people in general are at a higher risk because they tend to be more social and do not heed warnings as much.

He also said there still needs to be a better understanding between the immune system and the virus, but younger people could be at a high risk due to other factors like smoking and vaping.

While everything is currently on a pause, Brown said it is crucially important for investigators and decision makers to devise a way to manage the virus and bring back some semblance of normal life.

“I heard it said, this may be the new normal. This can’t be the new normal,” Brown said. “We cannot continue to live life this way both from an economic standpoint and a health standpoint. People can’t go a year without going to the doctor for important things. We are going to have to figure out how to manage this and how to control it and how to flatten the curve.”