One world, one pandemic, many guidelines: management of liver diseases during COVID-19

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) is responsible for the current global pandemic of COVID- 19, which is associated with significant morbidity and mortality.<sup>1</sup> As of 26 April 2020, it has infected over three million people worldwide and caused more than 200 000 deaths.<sup>2</sup> Chronic liver diseases from HCV, HBV, alcoholism or non-alcoholic fatty liver disease (NAFLD) represent a major disease burden in the world. Around 1.5 billion people have chronic liver diseases worldwide, and it causes around two million deaths per year. While self-resolving elevations of transaminases are reported in 15%–54% of patients with COVID-19, those with more severe disease experience worse liver injury.<sup>3–5</sup> An open international registry, SECURE-Cirrhosis, is reporting a mortality rate of 40% among the 118 patients with cirrhosis.<sup>6</sup> Thus, patients with chronic liver disease represent a vulnerable population who are at higher risk of acquiring COVID-19 and suffering from its complications.<sup>7 8</sup>