The Pandemic Hurt Patients With Liver Disease in Many Ways

Laird Harrison

June 30, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic has worsened the health of patients with liver disease worldwide, researchers say.

Not only does liver disease make people more vulnerable to the virus that causes COVID-19, precautions to prevent its spread have delayed healthcare and worsened alcohol abuse.

At this year's virtual International Liver Congress (ILC) 2021, experts from around the world documented this toll on their patients.

Surgeons have seen a surge in patients needing transplants because of alcoholic liver disease, the campaign to snuff out hepatitis C slowed down, and procedures such as endoscopy and ultrasound exams were postponed, said Mario Mondelli, MD, PhD, a professor and consultant physician of infectious diseases at the University of Pavia, in Pavia, Italy.

"We were able to ensure only emergency treatments, not routine surveillance," he told Medscape Medical News.

Of 1994 people with chronic liver disease who responded to a survey through the Global Liver Registry, 11% reported that the pandemic had affected their liver health.

This proportion was not statistically different for the 165 patients (8.2%) who had been diagnosed with COVID-19 compared with those who had not. But many of those who had been diagnosed with COVID-19 reported that it severely affected them. They reported worse overall heath, more mental illness, and greater need for supportive service than those who evaded the virus. Thirty-three respondents (20.8%) were hospitalized.

The global effort to eradicate hepatitis C slowed as a result of the pandemic. Already in 2019, the United States was behind the World Health Organization (WHO) schedule for eliminating this virus. In 2020, it slipped further, with 25% fewer patients starting treatment for hepatitis C than in 2019, according to researchers at the US Centers for Disease Control and Prevention.

Similar delays in eliminating hepatitis C occurred around the world, Mondelli said, noting that the majority of countries will not be able to reach the WHO objectives.

One striking result of the pandemic was an uptick of patients needing liver transplants as a result of alcoholic liver disease, said George Cholankeril, MD, a liver transplant surgeon at Baylor College of Medicine, in Houston, Texas.

Before the pandemic, he and his colleagues had noted an increase in the number of people needing liver transplants because of alcohol abuse. During the pandemic, that trend accelerated.

They defined the pre-COVID era as June 1, 2019, to February 29, 2020, and the COVID era as after April 1, 2020. In the COVID era, alcoholic liver disease accounted for 40% of patients whom the hospital put on its list for liver transplant. Hepatitis C and nonalcoholic fatty liver disease combined accounted for only 36%.

The change has resulted in part from the effectiveness of hepatitis C treatments, which have reduced the number of patients with livers damaged by that virus. But the change also resulted from the increased severity of illness in the patients with alcoholic liver disease, Cholankeril told Medscape Medical News. Overall, Model for End-Stage Liver Disease scores ― which are used to predict survival ― worsened for patients with alcoholic liver disease but remained the same for patients with nonalcoholic liver disease.

In the pre-COVID era, patients with alcoholic liver disease had a 10% higher chance for undergoing transplant compared to patients with nonalcoholic liver disease. In the COVID era, they had a 50% higher chance, a statistically significant change (P < .001).

The finding parallels those of other studies that have shown a spike in consults for alcohol-related gastrointestinal and liver diseases, as reported by Medscape Medical News.

"We feel that the increase in alcoholic hepatitis is possibly from binge drinking and alcoholic consumption during the pandemic," said Cholankeril. "Anecdotally, I can't tell you how many patients say that the video meetings for Alcoholic Anonymous just don't work. It's not the same as in person. They don't feel that they're getting the support that they need."

In Europe, fewer of the people who need liver transplants may be receiving them, said Mondelli.

"There are several papers indicating, particularly in Italy, in France, and in the United Kingdom, that during the pandemic, the offer for organs significantly declined," he said.

Other studies have shown increases in mortality from liver disease during the pandemic, Mondelli said. The same is true of myocardial infarction, cancer, and most other life-threatening illnesses, he pointed out.

"Because of the enormous tsunami that has affected hospital services during the peaks of the pandemic, there has been an increase in deceased patients from a variety of other diseases, not only liver disease," he said.

But Mondelli also added that physicians had improved in their ability to safely care for their patients while protecting themselves over the course of the pandemic.

Mondelli and Cholankeril have disclosed no relevant financial relationships.

International Liver Congress (ILC) 2021: Abstracts PO-1551, PO-2417, and LBP-2814. Presented June 23–26, 2021.

Laird Harrison writes about science, health, and culture. His work has appeared in magazines, newspapers, and online publications. He is at work on a novel about alternate realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at or follow him on Twitter: @LairdH.

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