ROUTINE FOLLOW-UP MONITORING OF OUT-PATIENTS WITH VIRUS-ASSOCIATED LIVER CIRRHOSIS DURING THE COVID-19 PANDEMIC PERIOD
Abstract
Background. Liver cirrhosis (LC) is the end stage of a number of chronic liver diseases, at least half of the cases being due to chronic viral hepatitis B and C. Higher morbidity and mortality from COVID-19 have been proven in patients with cirrhosis. Poor access to routine follow-up monitoring in many countries during the Covid-19 pandemic period has negatively impacted LC (including virus-associated one) prognosis.
Objective. To evaluate the effectiveness of routine follow-up monitoring of patients with virus-associated LC in Gomel during the COVID-19 pandemic period.
Material and methods. 127 medical records of outpatients with virus-associated LC registered at the Gomel Central City Clinical Polyclinic over 2020-2021 were analyzed. Markers of hepatitis C virus infection were detected in 92.1%, those of hepatitis B virus infection - in 7.9% of the patients.
Results. 38.6% of the patients underwent a complete follow-up examination, 48.8% had an incomplete one, 12.6% did not attend it. Those having skipped the examination were more likely to consult a doctor because of physical complaints (χ2=9.77, p=0.002), 32.3% of them being hospitalized. The total number of examined patients with class A cirrhosis (according to the Child-Pugh score) accounted for 26%, those with class B - to 44%, with class C – to 49%.
Conclusions. It is necessary to provide LC patients with comprehensive follow-up monitoring even during the COVID-19 pandemic period.
References
Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650-2666. https://doi.org/10.1016/j.cgh.2019.07.060
Yoshiji H, Nagoshi S, Akahane T, Asaoka Y, Ueno Y, Ogawa K, Kawaguchi T, Kurosaki M, Sakaida I, Shimizu M, Taniai M, Terai S, Nishikawa H, Hiasa Y, Hidaka H, Miwa H, Chayama K, Enomoto N, Shimosegawa T, Takehara T, Koike K. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J Gastroenterol. 2021;56(7):593-619. https://doi.org/10.1007/s00535-021-01788-x
GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245-266. https://doi.org/10.1016/S2468-1253(19)30349-8
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. https://doi.org/10.1056/NEJMoa2002032
Kovalic AJ, Satapathy SK, Thuluvath PJ. Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-analysis. Hepatol Int. 2020;14(5):612-620. https://doi.org/10.1007/s12072-020-10078-2
Iavarone M, D'Ambrosio R, Soria A, Triolo M, Pugliese N, Del Poggio P, Perricone G, Massironi S, Spinetti A, Buscarini E, Viganò M, Carriero C, Fagiuoli S, Aghemo A, Belli LS, Lucà M, Pedaci M, Rimondi A, Rumi MG, Invernizzi P, Bonfanti P, Lampertico P. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol. 2020;73(5):1063-1071. https://doi.org/10.1016/j.jhep.2020.06.001
Zhai M, Long J, Liu S, Liu C, Li L, Yang L, Li Y, Shu B. The burden of liver cirrhosis and underlying etiologies: results from the global burden of disease study 2017. Aging (Albany NY). 2021;13(1):279-300. https://doi.org/10.18632/aging.104127
Zou X, Fang M, Li S, Wu L, Gao B, Gao H, Ran X, Bian Y, Li R, ShanshanYu, Ling J, Li D, Tian D, Huang J. Characteristics of Liver Function in Patients with SARSCoV-2 and Chronic HBV Coinfection. Clin Gastroenterol Hepatol. 2021;19(3):597-603. https://doi.org/10.1016/j.cgh.2020.06.017
Skladany L, Koller T, Adamcova Selcanova S, Vnencakova J, Jancekova D, Durajova V, Laffers L, Svac J, Janickova K, Palkovič M, Kohout P, Golubnitschaja O. Challenging management of severe chronic disorders in acute pandemic situation: Chronic liver disease under COVID-19 pandemic as the proof-of-principle model to orchestrate the measures in 3PM context. EPMA J. 2021;12(1):1-14. https://doi.org/10.1007/s13167-021-00231-8
Marjot T, Moon AM, Cook JA, Abd-Elsalam S, Aloman C, Armstrong MJ, Pose E, Brenner EJ, Cargill T, Catana MA, Dhanasekaran R, Eshraghian A, García-Juárez I, Gill US, Jones PD, Kennedy J, Marshall A, Matthews C, Mells G, Mercer C, Perumalswami PV, Avitabile E, Qi X, Su F, Ufere NN, Wong YJ, Zheng MH, et al. Outcomes following SARSCoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2021;74(3):567-577. https://doi.org/10.1016/j.jhep.2020.09.024
Hamid S, Alvares da Silva MR, Burak KW, Chen T, Drenth JPH, Esmat G, Gaspar R, LaBrecque D, Lee A, Macedo G, McMahon B, Ning Q, Reau N, Sonderup M, van Leeuwen DJ, Armstrong D, Yurdaydin C. WGO Guidance for the Care of Patients with COVID-19 and Liver Disease. J Clin Gastroenterol. 2021;55(1):1-11. https://doi.org/10.1097/MCG.0000000000001459
Toyoda H, Huang DQ, Le MH, Nguyen MH. Liver Care and Surveillance: The Global Impact of the COVID-19 Pandemic. Hepatol Commun. 2020;4(12):1751-1757. https://doi.org/10.1002/hep4.1579
Téllez L, Martín Mateos RM. COVID-19 and liver disease: An update. Gastroenterol Hepatol. 2020;43(8):472-480. https://doi.org/10.1016/j.gastrohep.2020.06.006