Chapter of Gastroenterologists professional guidance for management of patients with liver disease in Singapore during the COVID-19 pandemic

Chang, Jaerak; Wong, Yu Jun; Yang, Wei; Lim, Kieron; Tan, Poh Seng; Ho, Gim Hin; Yip, Benjamin Cherng Hann; Li, Weiquan; Chong, Chia-Yin; Ong, David; Chua, Tju Siang; Vu, Charles; Gwee, Kok‐Ann; Tan, Chee Kiat

doi:10.11622/smedj.2020069

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…While growing evidence suggested a higher incidence of liver injury among severe COVID-19, such findings are not consistent [ [8] , [9] , [10] ]. Recent position statement highlighted our gaps in understanding this novel disease [ [11] , [12] , [13] ]. In particular, patients with non-alcoholic fatty liver disease may have co-existing comorbidities which put them at a higher risk of severe COVID-19 [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the COVID-19 associated liver injury

Wong

Tan

Zheng

et al. 2020

Annals of Hepatology

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Introduction and Objectives The novel coronavirus disease 2019 (COVID-19) has affected more than 5 million people globally. Data on the prevalence and degree of COVID-19 associated liver injury among patients with COVID-19 remain limited. We conducted a systematic review and meta-analysis to assess the prevalence and degree of liver injury between patients with severe and non-severe COVID-19. Methods We performed a systematic search of three electronic databases (PubMed/MEDLINE, EMBASE and Cochrane Library), from inception to 24 th April 2020. We included all adult human studies (>20 subjects) regardless of language, region or publication date or status. We assessed the pooled odds ratio (OR), mean difference (MD) and 95% confidence interval (95%CI) using the random-effects model. Results Among 1543 citations, there were 24 studies (5961 subjects) which fulfilled our inclusion criteria. The pooled odds ratio for elevated ALT (OR = 2.5, 95%CI: 1.6-3.7, I 2 = 57%), AST (OR = 3.4, 95%CI: 2.3-5.0, I 2 = 56%), hyperbilirubinemia (OR = 1.7, 95%CI: 1.2-2.5, I 2 = 0%) and hypoalbuminemia (OR = 7.1, 95%CI: 2.1-24.1, I 2 = 71%) were higher subjects in critical COVID-19. Conclusion COVID-19 associated liver injury is more common in severe COVID-19 than non-severe COVID-19. Physicians should be aware of possible progression to severe disease in subjects with COVID-19-associated liver injury.

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Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the COVID-19 associated liver injury

Wong

Tan

Zheng

et al. 2020

Annals of Hepatology

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“…A summary of the liver management and recommendations are given in Table 4. [98][99][100][101][102][103][104][105][106][107][108][109][110] Diagnostic aspects. Liver function tests and abdominal imaging are the primary investigations done in relation to liver involvement in COVID-19 patients.…”

Section: Management Of Liver Involvement In Covid-19mentioning

confidence: 99%

“…Although clues about the underlying pathological processes may be obtained, the influence of such findings on clinical management would be limited. 102 The American Association for the Study of Liver Diseases (AASLD) recommends the consideration of causes unrelated (e.g., hepatitis B virus [HBV] or hepatitis C virus [HCV]) to COVID-19 and other causes (e.g., myositis, ischemia, and cytokine release syndrome) for any liver test abnormalities. 102 In areas where viral hepatitis is prevalent, serological investigations for viral hepatitis may be considered depending on the clinical circumstances.…”

Section: Management Of Liver Involvement In Covid-19mentioning

confidence: 99%

“…102 The American Association for the Study of Liver Diseases (AASLD) recommends the consideration of causes unrelated (e.g., hepatitis B virus [HBV] or hepatitis C virus [HCV]) to COVID-19 and other causes (e.g., myositis, ischemia, and cytokine release syndrome) for any liver test abnormalities. 102 In areas where viral hepatitis is prevalent, serological investigations for viral hepatitis may be considered depending on the clinical circumstances. In regions where it is less prevalent, monitoring of hepatic functions would suffice and further investigation for causes, may be restricted to cases where the hepatic functions do not normalize within a reasonable time frame (such as 2-3 months of its first detection).…”

Section: Management Of Liver Involvement In Covid-19mentioning

confidence: 99%

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Involvement of the Liver in COVID-19: A Systematic Review

Kariyawasam

Jayarajah

Abeysuriya

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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COVID-19, a respiratory viral infection, has affected 388 million individuals worldwide as of the February 4, 2022. In this review, we have outlined the important liver manifestations of COVID-19 and discussed the possible underlying pathophysiological mechanisms and their diagnosis and management. Factors that may contribute to hepatic involvement in COVID-19 include direct viral cytopathic effects, exaggerated immune responses/systemic inflammatory response syndrome, hypoxia-induced changes, vascular changes due to coagulopathy, endothelitis, cardiac congestion from right heart failure, and drug-induced liver injury. The majority of COVID-19-associated liver symptoms are mild and self-limiting. Thus management is generally supportive. Liver function tests and abdominal imaging are the primary investigations done in relation to liver involvement in COVID-19 patients. However, imaging findings are nonspecific. Severe acute respiratory syndrome coronavirus 2 RNA has been found in liver biopsies. However, there is limited place for liver biopsy in the clinical context, as it does not influence management. Although, the management is supportive in the majority of patients without previous liver disease, special emphasis is needed in those with nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, hepatitis B and C infections, and alcoholic liver disease, and in liver transplant recipients.

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“…The course of SARS-CoV-2-induced COVID-19 is modulated by preexisting cardiovascular and metabolic disorders, which predispose to a more severe course and dangerous health issues such as obesity and metabolic associated fatty liver disease (MAFLD) [3,4].…”

mentioning

confidence: 99%

HSV infections during the COVID-19 pandemic

Brzeziński¹,

Wollina²

2020

Our Dermatol Online

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The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) producing aggressive interstitial pneumonia has rapidly spread from its origin of emergence in Wuhan, China, to numerous countries worldwide [1]. Globally, infections are still increasing in number (3,318,442 as of 11:00 on May 1, 2020), similarly to the situation in Poland (12,877 cases) and in Germany (163,009 cases). Some departments, clinics, and even entire hospitals have been transformed into infectious and observationalinfectious departments. Our dermatology department was transformed into an observational-infectious department.

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Chapter of Gastroenterologists professional guidance for management of patients with liver disease in Singapore during the COVID-19 pandemic

Cited by 5 publications

References 24 publications

A systematic review and meta-analysis of the COVID-19 associated liver injury

A systematic review and meta-analysis of the COVID-19 associated liver injury

Involvement of the Liver in COVID-19: A Systematic Review

HSV infections during the COVID-19 pandemic

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