Abstract
Coronavirus causes an outbreak of viral pneumonia that spread throughout the world. Liver injury is becoming more widely recognized as a component of the clinical picture of COVID-19 infection. We aimed to review this relation in a concise way. This review article includes a large number of patients from both western and eastern countries with no clear difference of liver affection. The more severe and frequent liver injury, the more severe COVID-19 infection. Up to half of patients developed hepatitis with serum ALT elevation. Both hepatocellular and/or ductular injury were observed as evidenced by alkaline phosphatase elevation. Increase incidence of morbidity and mortality had been recorded in patients with CLD. Cirrhosis mortality extended in line with the Child-Turcotte-Pugh class. The incidence of ACLF in CLD patients with COVID 19 is not clear. There are no significant associations with the etiology of liver disease and death in cirrhosis. COVID-19 hinders HCV elimination by 2030. Patients should continue their medications if already receiving treatment. Patients with occult or resolved HBV and COVID-19 who are receiving immunosuppressive agents should use antiviral therapy to prevent viral flare-ups.
Highlights
Liver injury is becoming more widely recognized as a component of the clinical picture of COVID-19 infection
A novel coronavirus designated as SARS-CoV-2, broke out in the city of Wuhan, China, at the end of 2019, causing the outbreak of viral pneumonia and spread all over the world [1] [2]; it was named “COVID-19” [3]
Pathogenesis and Pathophysiology: Liver injury is becoming more widely recognized as a component of the clinical picture of COVID-19 infection
Summary
A novel coronavirus designated as SARS-CoV-2, broke out in the city of Wuhan, China, at the end of 2019, causing the outbreak of viral pneumonia and spread all over the world [1] [2]; it was named “COVID-19” [3]. Half of the patients infected with severe SARS-CoV-2 showed hepatitis with serum ALT elevation [9] [10]. In the hospital FIB-4 had a significant prognostic value for poor outcomes in COVID-19 patients [13]. Direct cell damage by SARS-CoV-2 is possible due to the presence of ACE 2 entry receptors in the liver, in bile duct cells [16]. Antibiotics, antivirals, traditional Chinese medicine, and secondary bacterial infection, on the other hand, may cause liver damage in COVID-19 patients [17]. This finding is supported by a multicenter study conducted in Italy [29]
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