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LIVER DISEASE


Advances in hepatology: researching cirrhosis, HBV and intestinal microflora


New research into the growing burden of liver disease was highlighted at the recent International Liver Congress. High on the agenda was the severe impact of COVID-19 on patients with decompensated cirrhosis, along with an overview of HBV and new findings on the role of intestinal 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 in 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 multi-organ 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 (ie age, male gender, and co-morbidities 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.


The International Liver Congress presented important research that will help further the understanding of liver diseases


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COVID-19 has also had a profound impact in liver transplantation, with an abrupt drop in transplant activity coinciding with the pandemic. This has necessitated modification of transplant programmes, reprioritisation of transplant candidates, re-evaluation of risk on an


DECEMBER 2020 WWW.PATHOLOGYINPRACTICE.COM


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