Abstract
Introduction: The severity of COVID-19 may be correlated with the risk of liver injury development. An increasing number of studies indicate that degrees of hepatotoxicity has been associated with using some medications in the management of COVID-19 patients. However, limited studies had systematically investigated the evidence of drug-induced liver injury (DILI) in COVID-19 patients. Thus, this study aimed to examine DILI in COVID-19 patients.Methods: A systematic search was carried out in PubMed/Medline, EMBASE, and Web of Science up to December 30, 2020. Search items included “SARS-CoV-2”, “Coronavirus,” COVID-19, and liver injury.Results: We included 22 related articles. Among included studies, there was five case report, five case series, four randomizes control trial (RCT), seven cohort studies, and one cross-sectional study. The drugs included in this systematic review were remdesivir, favipiravir, tocilizumab, hydroxychloroquine, and lopinavir/ritonavir. Among included studies, some studies revealed a direct role of drugs, while others couldn't certainly confirm that the liver injury was due to SARS-CoV-2 itself or administration of medications. However, a significant number of studies reported that liver injury could be attributable to drug administration.Discussion: Liver injury in COVID-19 patients could be caused by the virus itself or the administration of some types of drug. Intensive liver function monitoring should be considered for patients, especially patients who are treated with drugs such as remdesivir, lopinavir/ritonavir, and tocilizumab.
Highlights
The severity of COVID-19 may be correlated with the risk of liver injury development
We reviewed any studies reporting liver injury and liverrelated adverse events caused by drug administration in COVID19 patients including case reports, case series, case- controls, cohorts, clinical trials and observational studies
The majority of included studies (11 studies) evaluated the safety of remdesivir for liver function, six studies reported safety of lopinavir/ritonavir, three studies assessed the safety of tocilizumab, three studies reported the safety of hydroxychloroquine
Summary
The severity of COVID-19 may be correlated with the risk of liver injury development. An increasing number of studies indicate that degrees of hepatotoxicity has been associated with using some medications in the management of COVID-19 patients. Epidemiological studies [3] indicate different degrees of elevated liver chemistries with an incidence of 24.4%, in liver transaminases, Aspartate transaminase (AST), and Alanine aminotransferase (ALT) in COVID-19 patient [5]. It’s been shown that the severity of COVID-19 is correlated with the risk of liver injury development [8, 9]. The CT-quantified liver/spleen attenuation ratio has further proved the liver damage in COVID-19 patients, which was correlated with the severity of the disease [12]. It is essential to find out the underlying mechanisms of these liver manifestations to prevent such adverse effects
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