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Review
. 2022 Feb;46(2):101793.
doi: 10.1016/j.clinre.2021.101793. Epub 2021 Aug 21.

COVID-19 and liver dysfunction: Epidemiology, association and potential mechanisms

Min Du  1 , Song Yang  2 , Min Liu  1 , Jue Liu  3
Affiliations
Review

COVID-19 and liver dysfunction: Epidemiology, association and potential mechanisms

Min Du et al. Clin Res Hepatol Gastroenterol. 2022 Feb.

Abstract

Currently, there have been more than one hundred million confirmed cases of coronavirus disease 2019 (COVID-19), with two million deaths worldwide. This has caused a huge medical burden. Severe COVID-19 patients can experience multi-organ damage, including cardiac injury, kidney injury, and liver injury. About 2.0%-4.9% of COVID-19 cases involve patients with preexisting liver diseases. Additionally, preexisting liver diseases were reported and associated with severity (odds ratio (OR) or risk ratio (RR) = 1.48-1.70) and mortality (OR or RR = 1.08-2.65) among COVID-19 patients. Furthermore, the prevalence of liver injury was 16%-29% in COVID-19 patients. Higher prevalence of liver injury may worsen prognosis in patients (severity: OR or RR = 1.9-2.6; mortality: OR or RR = 1.1-4.0). The mechanisms of this association between liver injury and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection are complex, including direct cholangiocyte damage induced by SARS-COV-2, cytokine storm, and drug-induced liver injury. In particular, drug-induced liver injury may be the most important reason. This review discusses the epidemiology of COVID-19 and liver dysfunction as well as potential mechanisms underlying the association between COVID-19 and liver dysfunction or other preexisting liver diseases. However, the association between preexisting liver diseases and COVID-19 prognosis and potential mechanisms underlying these associations require further prospective studies.

Keywords: COVID-19; Liver dysfunction; Systematic review.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no conflict of interest.

Figures

Fig 1
Fig. 1
Possible mechanisms of liver damage in COVID-19 patients. ACE2: angiotensin-converting enzyme 2; IL: interleukin; TNF: tumor necrosis factor.
See this image and copyright information in PMC

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