ABSTRACT
Background: CLD patients may experience substantial burden and disruption of life associated with COVID-19 pandemic. The aim was to assess the impact of COVID-19 pandemic on CLD patients. Methods: CLD patients from our Global Liver and Global NASH Registries (GLR/GNR) were invited to complete a COVID-19 survey with 23 items starting March 2020. Questions included whether patients had been infected with COVID-19, characteristics of the illness for those who had been infected, and various aspects of pandemicrelated disruptions of life regardless of being diagnosed with COVID-19. Results: Out of 10,500 GLR/GNR enrollees, 2500 from 7 countries completed the survey: 20% chronic hepatitis B (CHB), 14% chronic hepatitis C (CHC), and 66% non-alcoholic fatty liver disease (NAFLD), mean (SD) age 49±13 years, 53% male. Of all survey completers, 9.3% had had COVID-19. Of those infected, 86% were diagnosed by laboratory test, 93% had least one symptom, 75% received treatment for their symptoms. The mean duration of illness was 12.5±10.5 days, 64% reported receiving antiviral treatment, 19% were hospitalized, 13% needed oxygen support, no one required mechanical ventilation. Of patients regardless of COVID-19 diagnosis, 11.3% reported that the pandemic had an impact on their liver disease with 73% reporting delays in follow-up care. The Life Disruption Event Perception (LDEP) questionnaire confirmed that 81% of COVID-19-infected patients vs. 69% patients without COVID-19 (p=0.0001) experienced worsening in at least one aspect of their life (Figure). Self-assessed health scores were lower in patients with COVID-19: 6.7±2.2 vs. 7.4±2.2 (on a 1-10 scale with 10 indicating perfect health) (p<0.0001) despite having reported similar scores before the pandemic (8.5±1.4 vs. 8.4±1.6, p=0.59). The highest proportion of exercise and social impairments were reported from Turkey and Mexico, respectively. In multivariate analysis, after adjustment for country of enrollment, liver disease etiology and severity, age, sex, BMI, diabetes, history of psychiatric comorbidities, having had COVID-19 was found to be independently associated with lower self-assessed health scores (β=-0.71±0.14, p<0.0001). Conclusion: CLD patients experience substantial burden of COVID-19 pandemic on their daily lives regardless of whether they had been infected. However, self-reported health scores were lower in CLD patients with COVID-19 infection in comparison to those who did not have it.