Patients with cirrhosis during the COVID-19 pandemic: Current evidence and future perspectives

Table 3 Guidelines recommended for the management of cirrhosis patients during the COVID-19 pandemic

	EASL	AASLD	APASL
Outpatient	Common rules of physical distancing	Limited outpatient visitsWearing mask and keeping appropriate distancing	Phone or telemedicine
	Early admission for patient infected with SARS-CoV-2	Limited family or friend accompanied	Limited travel
	Prevent decompensation (e.g., variceal bleeding, HE, SBP) and avoid admission	Video conference, phone or telemedicine	Continue hepatitis B and C treatment
	Telemedicine or remote monitor	Provide prescriptions for 90 d instead of 30 dLimited travel
	Continue hepatitis B and C treatment	Continue hepatitis B and C treatment
	Receive vaccination for Streptococcus pneumoniae and influenza
Inpatient	Designate non-COVID-19 ward	Designate non-COVID-19 ward	Option of palliative treatment for advanced liver disease with COVID-19 disease
	Perform SARS-CoV-2 testing in patient with new or worsening decompensation or ACLF	Perform SARS-CoV-2 testing in patient with new or worsening decompensation or ACLF
	Option of palliative treatment for patient with advanced liver disease with COVID-19	Minimize interaction and transport for patient
		Telemedicine equipmentLimit patient visitors
Endoscopy	Limit to emergency (e.g., GI bleeding or bacterial cholangitis) in patient with COVID-19	Limit to emergency (e.g., GI bleeding or bacterial cholangitis) in patient with COVID-19	Limit to emergency (e.g., GI bleeding or bacterial cholangitis) in patient with COVID-19
	SARS-CoV-2 testing prior to endoscopic procedureNo delay in endoscopy in areas with low COVID-19 burden	SARS-CoV-2 testing prior to endoscopic procedure	PPE used in endoscopy for patient and staff
	Noninvasive tool for variceal surveying	PPE used in endoscopy for patient and staff	Variceal survey can be arbitrary postponed 3 mo depend on COVID-19 outbreak.
		Clean and disinfect the operation room	Noninvasive tool for variceal survey
		Prophylaxis with beta-blocker instead of endoscopic screening	Prophylaxis with beta-blocker instead of endoscopic screening
HCC surveillance	Deferred in patients with COVID-19 until recovery	Deferred in patients with COVID-19 until recovery	Prioritized for patients at high risk
	Prioritized for patients at high risk (e.g., elevated alpha-fetoprotein level or advanced cirrhosis	Continued radiological surveillance, but an arbitrary delay of 2 mo is reasonable	Continued radiological surveillance, but an arbitrary delay of 3 mo is reasonable

EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Disease; APASL: Asian Pacific Association for the Study of the Liver; COVID-19: Coronavirus disease-2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; HE: Hepatic encephalopathy; SBP: Spontaneous bacterial peritonitis; ACLF: Acute on chronic liver failure; GI: Gastrointestinal; PPE: Personal protective equipment; HCC: Hepatocellular carcinoma