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Review
. 2021 Apr 28;9(2):247-255.
doi: 10.14218/JCTH.2021.00006. Epub 2021 Mar 22.

Coronavirus Disease-2019 (COVID-19) and the Liver

Anshuman Elhence  1 , Manas Vaishnav  1 , Sagnik Biswas  1 , Ashish Chauhan  2 , Abhinav Anand  1 , Shalimar  1
Affiliations
Review

Coronavirus Disease-2019 (COVID-19) and the Liver

Anshuman Elhence et al. J Clin Transl Hepatol. .

Abstract

Within a year of its emergence, coronavirus disease-2019 (COVID-19) has evolved into a pandemic. What has emerged during the past 1 year is that, apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) derives its name, it presents with a myriad of gastrointestinal (GI) and liver manifestations. Expression of the angiotensin-converting enzyme-2 (ACE-2) receptor throughout the GI tract and liver, which is the receptor for the SARS-CoV-2, may be responsible for the GI and liver manifestations. Besides acting directly via the ACE-2 receptor, the virus triggers a potent immune response, which might have a role in pathogenesis. The virus leads to derangement in liver function tests in close to 50% of the patients. The impact of these derangements in patients with a normal underlying liver seems to be innocuous. Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease, leading to high mortality. Evolving data suggests that, contrary to intuition, liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality. The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered. With newer variants of COVID-19, which can spread faster than the original strain, the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.

Keywords: ACLF; Cirrhosis; Transaminitis; Vaccine.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. GI and hepatic manifestations of COVID-19.
Fig. 2
Fig. 2. Multifactorial nature of liver injury in COVID-19.
See this image and copyright information in PMC

References

    1. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Available from: https://covid19.who.int/
    1. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–637. doi: 10.1002/path.1570. - DOI - PMC - PubMed
    1. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020:2020.02.03.931766. doi: 10.1101/2020.02.03.931766. - DOI
    1. Zhao B, Ni C, Gao R, Wang Y, Yang L, Wei J, et al. Recapitulation of SARS-CoV-2 infection and cholangiocyte damage with human liver ductal organoids. Protein Cell. 2020;11(10):771–775. doi: 10.1007/s13238-020-00718-6. - DOI - PMC - PubMed
    1. Li Y, Xiao SY. Hepatic involvement in COVID-19 patients: Pathology, pathogenesis, and clinical implications. J Med Virol. 2020;92(9):1491–1494. doi: 10.1002/jmv.25973. - DOI - PubMed

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