HE PATOLOGY
Advancing hepatology: research findings
New research into the growing burden of liver disease was recently highlighted at the International Liver Congress. High on the agenda was the severe impact of COVID on patients with decompensated cirrhosis, along with new findings on the role of gut microflora in alcohol-related liver disease.
Liver disease is expected to overtake heart disease as the biggest cause of premature death in the next few years. Investment into research, earlier detection and effective interventions will be vital if we are to reverse this growing trend and reduce the burden of disease. The International Liver Congress recently presented important research that will help further our understanding of liver diseases and help identify effective treatments to improve patient outcomes and reduce mortality. This year, owing to COVID-19 disruptions, the event was held entirely online. Sessions at the Digital International Liver Congress 2020 included the latest information on the multiorgan manifestations of COVID-19, risk factors for severe disease and how pre-existing liver disease may influence the clinical course of SARS-CoV-2. As well as the well-established risk factors (age, male sex, and comorbidities, such as cardiovascular disease and obesity), chronic liver disease may also increase the risk of severe COVID-19.
Data from the COVID-Hep and SECURE- cirrhosis registries have supported this, showing a stepwise increase in rates of major adverse outcomes, including death, with increasing severity of liver disease. For patients with decompensated cirrhosis, the
numbers were stark: 79% mortality once admitted to the intensive care unit (ICU), and 90% mortality once invasive ventilation is administered in this population. COVID-19 has also had a profound impact in the setting of liver transplantation,
Non-alcoholic fatty liver disease (NAFLD) is considered to be the liver manifestation of metabolic syndrome and affects up to 25% of adults worldwide. It is a progressive condition characterised by deposition of fat in the liver that, eventually, leads to inflammation and scarring (known as fibrosis).
NOVEMBER 2020
with an abrupt drop in transplant activity coinciding with the pandemic that has necessitated modification of transplant programmes, reprioritisation of transplant candidates, re-evaluation of risk on an almost daily basis, and potential temporary cessation of transplantation in areas where the virus is prevalent.
A key message was that although those who have undergone liver transplantation are at increased risk of COVID-19 infection, disease severity appears to be in line with that in the general population. Guidelines also broadly advise against reduction of immunosuppressive therapy as this has not been demonstrated to increase risk.
Liver fibrosis and diabetic patients Delegates also learned how liver fibrosis assessment in routine care for diabetic
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