An intensive program implemented in Wuhan, China, prevented COVID-19 in 82 outpatients and 29 inpatients with decompensated cirrhosis.
“Protecting susceptible populations is just as important as treating COVID-19 infection,” Dr. Mingkai Chen from Renmin Hospital of Wuhan University told Reuters Health by email. “Even to some extent, prevention may be more important than treatment in patients with chronic comorbidities, because such patients have a poor prognosis after infection with SARS-CoV-2.”
Dr. Chen and colleagues describe their experience of COVID-19 prevention in 111 patients with decompensated cirrhosis in their online report in The Lancet Gastroenterology and Hepatology.
Every three days for a total of 12 times in January and February, they sent a list of 14 precautions to take against COVID-19, including protective measures aimed at preventing infections and precautions for cirrhotic complications, to outpatients via WeChat.
They also implemented 16 precautionary measures for inpatients with decompensated cirrhosis, including hospital staff training, health education for patients and their companions, new processes for diagnosis and treatment, emergency plans, and suggestions for discharging patients.
At follow-up, none of these patients had clinical symptoms suggestive of COVID-19. There was one death in hospital resulting from multiple organ failure.
By comparison, five of 250 patients without cirrhosis and six of 38 healthcare workers were diagnosed with COVID-19 by casual testing on their ward. At five other hospitals in Wuhan over the same period, where this approach had not been implemented, 17 of 101 inpatients with decompensated cirrhosis were diagnosed with COVID-19.
“Patients with comorbidities have been identified as COVID-19 susceptible populations,” Dr. Chen said. “Our measures based on cirrhosis can also provide reference for other susceptible populations to prevent SARS-CoV-2 infection in the current outbreak.”
“Only when doctors realize the importance of protection can they properly educate and instruct patients,” Dr. Chen added. “In addition, remote Internet communication platforms such as WeChat can provide a more convenient, safe, and efficient communication way between doctors and patients.”
Dr. Rafael O. Ximenes from University of Sao Paulo School of Medicine in Brazil, who has researched predictors of infection and mortality in patients with cirrhosis who present to the emergency department, told Reuters Health by email, “Patients with decompensated cirrhosis are more susceptible to infection and unfavorable outcomes because of immune dysfunction and exacerbated inflammatory response. That can result in the so-called acute-on-chronic liver failure (ACLF), which is associated with organ dysfunction and a high mortality risk. We now know that viral infections may be the precipitant factor of ACLF, and probably that risk exists with COVID-19.”
“Physicians should use technology to educate patients with decompensated cirrhosis with preventive measures and to avoid them going to the healthcare system during COVID-19 pandemic whenever possible,” he said. “That will decrease their likelihood of getting infected with SARS-CoV-2 and having negative outcomes