Liver pathology in COVID-19 after end of pandemic: Modern view of problem

Abstract

The COVID‑19 pandemic, first reported in late 2019, despite ending in May 2023, continues to have a devastating impact on global health with significant associated morbidity and mortality rates. Liver injury is a common feature in patients with COVID‑19 and ranges from mild and temporary elevation of liver enzymes to severe liver damage and even acute liver failure. The purpose of this review is to present data on the prevalence, pathophysiological mechanisms, clinical manifestations, diagnosis, course features, complications, and treatment options for liver damage in patients with SARS-CoV‑2. Several pathophysiological mechanisms are responsible for liver damage in COVID‑19, including the direct cytotoxic effect of the virus, cytokine storm, hypoxia and ischemia of the organ, and drug hepatotoxicity. Patients with underlying chronic liver disease (CLD) (liver cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID‑19 and further liver deterioration. Some COVID‑19 patients experience post-covid syndrome, also known as post-acute COVID‑19, long-term COVID‑19 or long COVID‑19. The most common manifestations of post-covid syndrome in patients with liver pathology, both developed directly in connection with SARS-Cov‑2 infection, and in people with pre-existing CLD, include the phenomena of astheno-vegetative syndrome, as well as clinical and biochemical signs of moderate cytolysis and cholestasis syndrome.