AASLD发行《临床见解指南》，用于治疗肝病和COVID-19患者

StephenW

AASLD Releases Clinical Insight Guide for Treating Patients with Liver Disease and COVID-19
25-Mar-2020 1:15 PM EDT, by American Association for the Study of Liver Diseases (AASLD)

Newswise — ALEXANDRIA,VA – The American Association for the Study of Liver Disease (AASLD) has released a clinical insight document for clinicians and frontline healthcare providers who are treating patients with liver disease during the COVID-19 pandemic. The document, which cites recent studies conducted in China, assesses how hepatologists and liver transplant physicians/surgeons and their patients may be affected by the COVID-19 virus (also known as SARS-CoV-2) and provides continued guidance on clinical approaches to disease management.

“Our current understanding points to the fact that patients with cirrhosis, autoimmune hepatitis on immunosuppressive medications and pre- and post-transplant patients on immunosuppression may be among the most vulnerable patients who are at high risk of severe illness if they become infected with SARS-CoV-2,” says Raymond T. Chung, MD, FAASLD, AASLD president-elect and member of AASLD's COVID-19 Working Group. “Hepatologists and liver transplant programs in the US can help their patients, programs, hospitals and local communities by immediately implementing containment and mitigation policies that limit non-essential patient visits to clinics and hospital.”

The document highlights what is known about how COVID-19 affects the hepatobiliary system, including:

    Incidence of elevated liver biochemistries (mainly abnormal AST and ALT, slightly elevated bilirubin) ranges from 14.8-53% in COVID-19 patients.
    Liver injury is more common in more severe cases than in mild cases.
    Liver damage in mild cases is usually transient and does not require specific treatment.
    Low albumin is a marker of disease severity.
    SARS-CoV-2 uses ACE2 to gain entry into cells (same as SARS-CoV, which caused SARS in 2002-2003).

Also highlighted are some of the known issues clinicians should be aware of with regard to different treatment approaches for COVID-19. Studies cited in the document report that drugs taken to manage symptomatic COVID-19 may be hepatotoxic, including remdesivir and tocilizumab.

To prepare clinicians and frontline health care providers, the document also provides recommendations for approaching COVID-19 in different liver disease states, including, but not limited to, hepatocellular carcinoma (HCC), cirrhosis and post-liver transplant management.

Citing reports of health care worker infection rates as high as 20 percent, the document also offers guidance for protecting health care workers and best practices for workforce utilization. “In addition to protecting our patients and communities, we must protect our healthcare workers. If we do not contain the spread of the virus quickly, the capacity of our healthcare system will be overwhelmed, including availability of ICU beds, ventilators and healthcare workers,” explains Jorge A. Bezerra, MD, FAASLD, AASLD president and member of AASLD's COVID-19 Working Group.

The full document and additional resources can be found at aasld.org/COVID19. The document will be updated regularly as new information becomes available.

About the AASLD

AASLD is the leading organization of clinicians and researchers committed to preventing and curing liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

For questions or interview requests, please contact the AASLD media team at [email protected]

StephenW

AASLD发行《临床见解指南》，用于治疗肝病和COVID-19患者
由美国肝病研究协会（AASLD）于美国东部夏令时间2020年3月25日下午1:15

Newswise —弗吉尼亚州亚历山大—美国肝病研究协会（AASLD）已发布了针对在COVID-19大流行期间治疗肝病患者的临床医生和一线医疗服务提供者的临床见解文件。该文件引用了在中国进行的最新研究，评估了肝病学家和肝移植医师/外科医生及其患者如何受到COVID-19病毒（也称为SARS-CoV-2）的影响，并提供了有关临床方法的持续指导疾病管理。

“我们目前的理解指向以下事实：肝硬化，使用免疫抑制药物的自身免疫性肝炎以及移植前和移植后免疫抑制的患者可能是最容易感染严重急性呼吸道疾病的患者，如果他们感染了SARS- CoV-2，” FAASLD的医学博士Raymond T. Chung，AASLD的当选主席兼AASLD的COVID-19工作组成员。 “美国的肝病专家和肝脏移植计划可以通过立即实施遏制和缓解政策来限制患者不必要地访问诊所和医院，从而为他们的患者，计划，医院和当地社区提供帮助。”

该文档重点介绍了有关COVID-19如何影响肝胆系统的已知知识，包括：

    在COVID-19患者中，肝脏生物化学指标升高（主要是AST和ALT异常，胆红素水平略高）的发生率在14.8-53％之间。
    在较严重的情况下，肝损伤比在轻度的情况下更常见。
    在轻度病例中，肝损伤通常是短暂的，不需要特殊治疗。
    低白蛋白是疾病严重程度的标志。
    SARS-CoV-2使用ACE2进入细胞（与SARS-CoV相同，后者在2002-2003年导致SARS）。

还强调了一些临床医生应注意的有关COVID-19的不同治疗方法的已知问题。该文件中引用的研究报告称，用于治疗有症状COVID-19的药物可能具有肝毒性，包括瑞昔韦韦和托珠单抗。

为了准备临床医生和一线医疗服务提供者，该文件还提供了在不同肝病状态下治疗COVID-19的建议，包括但不限于肝细胞癌（HCC），肝硬化和肝移植后管理。

该文件引用了卫生保健工作者感染率高达20％的报告，还为​​保护卫生保健工作者提供了指导，并为劳动力利用提供了最佳实践。 “除了保护我们的患者和社区，我们还必须保护我们的医护人员。如果我们不能迅速遏制病毒的传播，我们的医疗保健系统的能力将不堪重负，包括ICU病床，呼吸机和医护人员的可用性。” AASLD主席兼AASLD会员Jorge A. Bezerra博士解释说COVID-19工作组。

完整的文档和其他资源可以在aasld.org/COVID19中找到。随着新信息的发布，该文档将定期更新。

关于AASLD

AASLD是致力于预防和治愈肝病的临床医生和研究人员的领先组织。我们成员的工作为开发用于治疗病毒性肝炎患者的药物奠定了基础。获得肝病研究的护理和支持是AASLD倡导工作的核心。

如有疑问或面试要求，请联系AASLD媒体团队，电子邮件：[email protected]。