> top > projects > LitCovid-sentences > docs > PMC:7242013 > annotations
LitCovid-sentences  

PMC:7242013 JSONTXT 17 Projects

Annnotations TAB TSV DIC JSON TextAE

Id Subject Object Predicate Lexical cue
T1 0-117 Sentence denotes Synthesis of Liver Associations Recommendations for Hepatology and Liver Transplant Care During the COVID‐19 Pandemic
T2 118-174 Sentence denotes Hepatology and Patient Care During the COVID‐19 Pandemic
T3 175-187 Sentence denotes Lau and Ward
T4 189-224 Sentence denotes Watch the interview with the author
T5 225-238 Sentence denotes Abbreviations
T6 239-297 Sentence denotes AASLD American Association for the Study of Liver Diseases
T7 298-326 Sentence denotes ALT alanine aminotransferase
T8 327-385 Sentence denotes APASL Asian Pacific Association for the Study of the Liver
T9 386-416 Sentence denotes AST aspartate aminotransferase
T10 417-440 Sentence denotes CHB chronic hepatitis B
T11 441-464 Sentence denotes CHC chronic hepatitis C
T12 465-490 Sentence denotes CLD chronic liver disease
T13 491-524 Sentence denotes COVID‐19 coronavirus disease 2019
T14 525-577 Sentence denotes EASL European Association for the Study of the Liver
T15 578-599 Sentence denotes HBV hepatitis B virus
T16 600-628 Sentence denotes HCC hepatocellular carcinoma
T17 629-650 Sentence denotes HCV hepatitis C virus
T18 651-673 Sentence denotes HCW health care worker
T19 674-698 Sentence denotes LT liver transplantation
T20 699-737 Sentence denotes NAFLD nonalcoholic fatty liver disease
T21 738-771 Sentence denotes NIH National Institutes of Health
T22 772-805 Sentence denotes PPE personal protective equipment
T23 806-864 Sentence denotes SARS‐CoV‐2 Severe Acute Respiratory Syndrome Coronavirus 2
T24 865-894 Sentence denotes TKI tyrosine kinase inhibitor
T25 895-920 Sentence denotes ULD upper limit of normal
T26 921-1243 Sentence denotes To navigate through the stormy unchartered ocean of SARS‐coV‐2 infections and coronavirus disease 2019 (COVID‐19), all practicing hepatologists and other clinicians caring for patients with liver disease need guidance based on the best documented and rapidly evolving knowledge regarding SARS‐CoV‐2 infection and COVID‐19.
T27 1244-1473 Sentence denotes Prevention of SARS‐CoV‐2 transmission requires the redesign of patient workflow and other measures ensuring delivery of elective and emergency hepatology services without compromising the safety of patients and medical personnel.
T28 1474-1750 Sentence denotes 1 , 2 Moreover, prevention of severe COVID‐19 and related mortality requires updating management of persons with chronic liver disease (CLD) to diagnose COVID‐19 and being vigilant for drug‐drug interactions and other potential complications of COVID‐19 in persons with CLD.
T29 1751-2029 Sentence denotes 3 To respond to an urgent need for such information, the Asian Pacific Association for the Study of the Liver (APASL) recently published recommendations of an expert committee to guide infection control and clinical management of patients with CLD during the COVID‐19 pandemic.
T30 2030-2253 Sentence denotes 4 Previously, two other regional liver associations, American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL), convened expert panels with the same objectives.
T31 2254-2492 Sentence denotes 5 , 6 This review summarizes the recommendations of the three liver associations for clinical practices to prevent SARS‐CoV‐2 transmission and protect persons with CLD from health risks posed by the emerging COVID‐19 pandemic (Table 1).
T32 2493-2607 Sentence denotes Table 1 Selected AASLD, APASL, and EASL Recommendations for Liver Disease Management During the COVID‐19 Pandemic
T33 2608-2643 Sentence denotes Recommendations AASLD APASL EASL
T34 2644-2718 Sentence denotes Limit nosocomial transmission Prioritize patients to limit in‐person care
T35 2719-2865 Sentence denotes On arrival, screen patients for COVID‐19 symptoms, exposures; if suggestive of COVID‐19, refer care per clinic’s protocol for symptomatic patients
T36 2866-2912 Sentence denotes Use telemedicine alternatives for routine care
T37 2913-2961 Sentence denotes Reduce routine laboratory and imaging monitoring
T38 2962-2994 Sentence denotes Prescribe 90 days of medications
T39 2995-3059 Sentence denotes Cancel all elective/nonurgent endoscopic procedures and biopsies
T40 3060-3102 Sentence denotes Limit in‐clinic evaluations for transplant
T41 3103-3161 Sentence denotes Limit clinical trial activity to essential clinical trials
T42 3162-3208 Sentence denotes Limit HCWs providing care or on patient rounds
T43 3209-3292 Sentence denotes HCWs follow recommendations for PPE Use telemedicine alternatives for routine care
T44 3293-3336 Sentence denotes Minimize number of HCWs caring for patients
T45 3337-3378 Sentence denotes Minimize number of HCWs on patient rounds
T46 3379-3436 Sentence denotes Cancel elective, nonurgent endoscopies and liver biopsies
T47 3437-3510 Sentence denotes HCWs follow recommendations for PPE Limit in‐person care to urgent cases
T48 3511-3553 Sentence denotes Remodel clinic space for social distancing
T49 3554-3615 Sentence denotes Use telemedicine for routine care; postpone specialist visits
T50 3616-3676 Sentence denotes Reduce frequency of laboratory monitoring and obtain locally
T51 3677-3712 Sentence denotes HCWs follow recommendations for PPE
T52 3713-3978 Sentence denotes Evaluate and care for patients with COVID‐19 for liver disease Prioritize for COVID‐19 testing: (1) patients with cirrhosis, (2) patients with CLD receiving immunosuppressive medications, and (3) patients with new‐onset encephalopathy or other acute decompensation
T53 3979-4017 Sentence denotes Regularly monitor liver biochemistries
T54 4018-4140 Sentence denotes Consider non‐COVID‐19 etiologies for liver disease: (1) exacerbation of preexisting CLD or (2) drug‐induced hepatotoxicity
T55 4141-4190 Sentence denotes Use acetaminophen 2 g/day as preferred medication
T56 4191-4241 Sentence denotes Use nonsteroidal anti‐inflammatory drugs as needed
T57 4242-4369 Sentence denotes Consult the University of Liverpool document to assess possible drug interactions Follow WHO guidelines for COVID‐19 diagnosis
T58 4370-4427 Sentence denotes Consider NAFLD as a prognostic factor for severe COVID‐19
T59 4428-4475 Sentence denotes Screen patients for hepatitis B surface antigen
T60 4476-4559 Sentence denotes Consider HBV prophylaxis prior to use of anti‐IL‐6, other immunosuppressive therapy
T61 4560-4609 Sentence denotes Monitor liver function tests of patients with CLD
T62 4610-4650 Sentence denotes Be alert to possible drug hepatotoxicity
T63 4651-4730 Sentence denotes Decompensated CLD and ALT >5 times ULD contraindications for remdesivir therapy
T64 4731-4890 Sentence denotes Prioritize persons with CLD for clinical trials Test for COVID‐19 patients with acute decompensation or acute‐on‐chronic liver and per institution’s practices
T65 4891-4969 Sentence denotes Persons with NAFLD likely to have comorbidity risk factors for severe COVID‐19
T66 4970-5044 Sentence denotes Consider patients with CLD/COVID‐19 for early admission and clinical trial
T67 5045-5092 Sentence denotes Use acetaminophen (2–3 g/day is generally safe)
T68 5093-5142 Sentence denotes Limit use of nonsteroidal anti‐inflammatory drugs
T69 5143-5253 Sentence denotes Test for COVID‐19 patients with acute decompensation or acute‐on‐chronic liver and per institution’s practices
T70 5254-5332 Sentence denotes Persons with NAFLD likely to have comorbidity risk factors for severe COVID‐19
T71 5333-5407 Sentence denotes Consider patients with CLD/COVID‐19 for early admission and clinical trial
T72 5408-5455 Sentence denotes Use acetaminophen (2–3 g/day is generally safe)
T73 5456-5505 Sentence denotes Limit use of nonsteroidal anti‐inflammatory drugs
T74 5506-5595 Sentence denotes Manage hepatitis B; hepatitis C Continue HBV and HCV treatment of patients with COVID‐19
T75 5596-5683 Sentence denotes Proceed with HBV and HCV treatment in patients without COVID‐19 as clinically warranted
T76 5684-5823 Sentence denotes Do not consider HBV treatment in patients with COVID‐19 unless flare is suspected Continue HBV and HCV treatment of patients with COVID‐19
T77 5824-5911 Sentence denotes Proceed with HBV and HCV treatment in patients without COVID‐19 as clinically warranted
T78 5912-5993 Sentence denotes Do not consider HBV treatment in patients with COVID‐19 unless flare is suspected
T79 5994-6065 Sentence denotes Document discussion with patient regarding CLD diagnosis and management
T80 6066-6178 Sentence denotes Manage patients with HCC Continue HCC surveillance schedule for high‐risk subjects; 2‐month delay is acceptable
T81 6179-6258 Sentence denotes Document discussion of risks and benefits of delaying surveillance with patient
T82 6259-6345 Sentence denotes Proceed with HCC treatments as appropriate Continue therapy for non‐COVID‐19 patients
T83 6346-6487 Sentence denotes For patients with HCC with COVID‐19, postpone elective transplant and resection surgery, withhold immunotherapy Maintain care per guidelines
T84 6488-6524 Sentence denotes Admit early if COVID‐19 is diagnosed
T85 6525-6558 Sentence denotes Consider postponing HCC therapies
T86 6559-6649 Sentence denotes Manage pretransplant and posttransplant patients Screen donors and recipient for COVID‐19
T87 6650-6721 Sentence denotes Do not postpone transplants (an essential medical service, CMS Tier 3b)
T88 6722-6791 Sentence denotes Notify patients of possible extended waiting times on transplant list
T89 6792-6884 Sentence denotes Have low threshold for admitting patients on transplant waiting list diagnosed with COVID‐19
T90 6885-6999 Sentence denotes For posttransplant patients with moderate COVID‐19, consider reduction of immunosuppression therapy as appropriate
T91 7000-7118 Sentence denotes Do not reduce immunosuppressive therapy in patients with mild COVID‐19 disease Test donors and recipient for COVID‐19
T92 7119-7173 Sentence denotes Limit transplant listing to emergency and urgent cases
T93 7174-7261 Sentence denotes Look for SARS‐COV‐2 prior to organ procurement; defer donors with evidence of infection
T94 7262-7335 Sentence denotes Consider specific COVD‐19 consent for patients on transplant waiting list
T95 7336-7449 Sentence denotes For posttransplant patient with moderate COVID‐19, consider reduction of immunosuppression therapy as appropriate
T96 7450-7558 Sentence denotes Do not reduce immunosuppressive therapy in patients with mild COVID‐19 disease Maintain care per guidelines
T97 7559-7632 Sentence denotes Limit transplantation listings to patients with poor short‐term prognosis
T98 7633-7668 Sentence denotes Vaccinate against pneumonia and flu
T99 7669-7714 Sentence denotes Avoid reductions in immunosuppressive therapy
T100 7715-7785 Sentence denotes Do not reduce immunosuppressive therapy in patients with mild COVID‐19
T101 7786-7933 Sentence denotes John Wiley & Sons, Ltd This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response.
T102 7934-8116 Sentence denotes It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.
T103 8118-8210 Sentence denotes How to Protect Medical Personnel and Patients With Liver Diseases From SARS‐CoV‐2 Infection?
T104 8211-8498 Sentence denotes To this end, all three associations recommend physical distancing by limiting face‐to‐face consultations to urgent situations, routine patient contact via telemedicine and phone visits, and use of local laboratories and pharmacies to reduce clinic and hospital visits and patient travel.
T105 8499-8650 Sentence denotes AASLD guidance is most stringent by discouraging clinic entry of anyone with fever or other COVID‐19 symptoms and SARS‐CoV‐2 testing of these patients.
T106 8651-8781 Sentence denotes All recommend COVID‐19 testing of liver transplant donors and recipients and patients with encephalopathy or acute decompensation.
T107 8782-8898 Sentence denotes Recent data showed that many SARS‐CoV‐2–infected patients are asymptomatic, yet capable of transmitting the disease.
T108 8899-9050 Sentence denotes 7 Ideally, all patients with a history of close contact with cases of possible or confirmed COVID‐19 or from high‐prevalence regions should be tested.
T109 9051-9133 Sentence denotes APASL recommends SARS‐CoV‐2 testing based on clinical and epidemiological factors.
T110 9134-9186 Sentence denotes EASL recommends following an institution’s practice.
T111 9187-9300 Sentence denotes AASLD and APASL describe the personal protective equipment (PPE) requirements for endoscopy and other procedures.
T112 9301-9373 Sentence denotes Like SARS‐CoV‐2 testing, the limiting factor is the availability of PPE.
T113 9374-9449 Sentence denotes Without adequate supply, many elective procedures will need to be canceled.
T114 9450-9552 Sentence denotes Modifications of the practice of liver transplantation (LT) are recommended by all three associations.
T115 9553-9742 Sentence denotes With the potential risks of SARS‐CoV‐2 transmission, aggravated by the limited supply of PPE and other resources, many governments have restricted elective medical procedures, including LT.
T116 9743-9854 Sentence denotes However, in the United States, LTs are considered “high‐acuity surgery” and can proceed as medically warranted.
T117 9855-10032 Sentence denotes 8 All associations recommend limiting LT to patients with high Model for End‐Stage Liver Disease scores, risk for decompensation, or hepatocellular carcinoma (HCC) progression.
T118 10034-10137 Sentence denotes Should LT be Performed in COVID‐19 Recipients, and Should One Use Organs Procured From COVID‐19 Donors?
T119 10138-10192 Sentence denotes AASLD recommends against LT in patients with COVID‐19.
T120 10193-10285 Sentence denotes LT can proceed 21 days after symptom resolution and negative diagnostic tests in recipients.
T121 10286-10392 Sentence denotes APASL suggests balancing risks of delaying LT against risks of transmission to health care workers (HCWs).
T122 10393-10439 Sentence denotes EASL does not specifically address this issue.
T123 10440-10636 Sentence denotes To minimize the risk to HCWs, APASL recommends LT be performed only in patients with COVID‐19 with at least two consecutive negative SARS‐CoV‐2 nucleic acid results and the presence of antibodies.
T124 10637-10735 Sentence denotes Finally, there is debate whether immunosuppression should be reduced during the COVID‐19 pandemic.
T125 10736-10847 Sentence denotes So far there are no data to suggest that posttransplant immunosuppression is a risk factor for severe COVID‐19.
T126 10848-10930 Sentence denotes In contrast, reducing immunosuppression may increase the risk for graft rejection.
T127 10931-11041 Sentence denotes All three associations recommend against reducing immunosuppressive therapy in LT patients with mild COVID‐19.
T128 11042-11191 Sentence denotes The dose of azathioprine, mycophenolate, and calcineurin inhibitor may be reduced in the setting of severe lymphopenia or worsening pulmonary status.
T129 11193-11275 Sentence denotes What Are the Roles of a Hepatologist in the Management of a Patient With COVID‐19?
T130 11276-11411 Sentence denotes Elevation of serum transaminase levels is commonly observed in patients with COVID‐19, and a hepatologist might therefore be consulted.
T131 11412-11588 Sentence denotes All of the guidance suggests that the underlying cause of liver injury may be related to SARS‐CoV‐2 infections, exacerbation of preexisting CLD, or drug‐induced hepatotoxicity.
T132 11589-11659 Sentence denotes AASLD and APASL provide an algorithm to clinical evaluations (Fig. 1).
T133 11660-11743 Sentence denotes A key question is whether patients with CLD have a higher risk for severe COVID‐19.
T134 11744-11929 Sentence denotes AASLD and APASL suggest nonalcoholic fatty liver disease (NAFLD) as an independent prognostic factor, and patients with CLD should be prioritized as candidates for COVID‐19 drug trials.
T135 11930-12058 Sentence denotes EASL and AASLD mention that patients with NAFLD are more likely than others to have other comorbidity risks for severe COVID‐19.
T136 12059-12235 Sentence denotes To date, there is no evidence that patients with stable CLD due to chronic hepatitis B (CHB) or chronic hepatitis C (CHC) have increased susceptibility to SARS‐CoV‐2 infection.
T137 12236-12385 Sentence denotes It is controversial whether there is an increased risk for flare‐up of CHB or CHC during COVID‐19 and whether prophylactic therapy should be started.
T138 12386-12479 Sentence denotes Both AASLD and APASL recommend continuing treatment for CHB or CHC in patients with COVID‐19.
T139 12480-12597 Sentence denotes APASL recommends prophylactic hepatitis B therapy for those planned for anti‐IL‐6 or other immunosuppressive therapy.
T140 12598-12661 Sentence denotes Initiating prophylactic hepatitis C therapy is not recommended.
T141 12662-12811 Sentence denotes If there is any suggestion of a flare‐up, therapy should be initiated in patients who are not already receiving hepatitis B or hepatitis C treatment.
T142 12812-12897 Sentence denotes Fig 1 Approach to the patient with COVID‐19 and elevated serum liver biochemistries.
T143 12898-12941 Sentence denotes Reproduced with permission from Hepatology.
T144 12942-13014 Sentence denotes 5 Copyright 2020, American Association for the Study of Liver Diseases.
T145 13015-13236 Sentence denotes On May 1, 2020, remdesivir, a nucleotide RNA polymerase inhibitor, was authorized by the US Food and Drug Administration under Emergency Use Authorization for treatment of those patients hospitalized with severe COVID‐19.
T146 13237-13373 Sentence denotes 9 APASL and AASLD recommend close monitoring of liver function in patients, especially those with CLD, who are treated with remdesivir.
T147 13374-13521 Sentence denotes Patients with decompensated CLD and those with alanine aminotransferase (ALT) >5 times upper limit of normal should not be treated with remdesivir.
T148 13523-13576 Sentence denotes How Should We Modify Management of Patients With HCC?
T149 13577-13702 Sentence denotes To avoid SARS‐CoV‐2 exposures, all associations recommend reducing patient visits and a delay in HCC ultrasound surveillance.
T150 13703-13986 Sentence denotes It is uncertain whether HCC treatment should be deferred or started as usual in patients with COVID‐19 with newly diagnosed HCC, and whether tyrosine kinase inhibitors (TKIs) or checkpoint inhibitors should be stopped in patients with COVID‐19 who are already receiving such therapy.
T151 13987-14256 Sentence denotes Delaying or withdrawing treatment increases the risk for HCC progression with detrimental outcomes, whereas surgical resection may increase risk for transmission to health care personnel, and checkpoint inhibitors might worsen COVID‐19 by exacerbating a cytokine storm.
T152 14257-14304 Sentence denotes AASLD recommends HCC treatments should proceed.
T153 14305-14447 Sentence denotes EASL recommends locoregional therapies should be postponed whenever possible and immune‐checkpoint inhibitor therapy be temporarily withdrawn.
T154 14448-14514 Sentence denotes TKI in nonsevere COVID‐19 should be taken on a case‐by‐case basis.
T155 14515-14757 Sentence denotes APASL recommends postponing elective transplant/resection surgery, whereas radiofrequency ablation, transcatheter arterial chemoembolization, TKI, or immunotherapy can be initiated with change of immunotherapy schedules to every 4 to 6 weeks.
T156 14759-14790 Sentence denotes How to Conduct Clinical Trials?
T157 14791-14922 Sentence denotes Both APASL and AASLD recommend using alternative physical distancing processes for study assessments to reduce SARS‐CoV‐2 exposure.
T158 14923-15181 Sentence denotes APASL specifically recommends seeking local regulators and institutional review board approval of the contingency measures during the COVID‐19 pandemic, obtaining trial participant’s consent, and documentation of all deviations from the contingency measures.
T159 15182-15307 Sentence denotes These recommendations align with US National Institutes of Health (NIH) revised guidance for NIH‐supported clinical research.
T160 15308-15310 Sentence denotes 10
T161 15312-15319 Sentence denotes Summary
T162 15320-15469 Sentence denotes APASL, AASLD, and EASL strongly recommend changes in patient workflow and clinical procedures to protect HCWs and patients from SARS‐CoV‐2 infection.
T163 15470-15747 Sentence denotes Similarly, the associations generally agree on approaches to evaluation and treatment of patients with COVID‐19 for liver disease, and management of patients with HCC and post–liver transplant patients with slight differences in the populations targeted for SARS‐CoV‐2 testing.
T164 15748-15858 Sentence denotes These recommendations will evolve with further clinical experience and data from randomized controlled trials.
T165 15859-15980 Sentence denotes For now, the liver associations provide the best available advice for the management of CLD during the COVID‐19 pandemic.