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Review
. 2021 Aug 6;9(22):6178-6200.
doi: 10.12998/wjcc.v9.i22.6178.

COVID-19 infection and liver injury: Clinical features, biomarkers, potential mechanisms, treatment, and management challenges

Gholam Reza Sivandzadeh  1 , Hassan Askari  1 , Ali Reza Safarpour  2 , Fardad Ejtehadi  1 , Ehsan Raeis-Abdollahi  3 , Armaghan Vaez Lari  4 , Mohammad Foad Abazari  5 , Firoozeh Tarkesh  1 , Kamran Bagheri Lankarani  6
Affiliations
Review

COVID-19 infection and liver injury: Clinical features, biomarkers, potential mechanisms, treatment, and management challenges

Gholam Reza Sivandzadeh et al. World J Clin Cases. .

Abstract

It is hypothesized that liver impairment caused by coronavirus disease 2019 (COVID-19) infection might play a central role in severe clinical presentations. Liver injury is closely associated with severe disease and, even with antiviral drugs, have a poor prognosis in COVID-19 patients. In addition to the common hepatobiliary disorders caused by COVID-19, patients with pre-existing liver diseases demand special considerations during the current pandemic. Thus, it is vital that upon clinical presentation, patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure. Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases, particularly in those with pre-existing metabolic liver injury. The purpose of this study was to determine most recent evidence regarding causality, potential risk factors, and challenges, therapeutic options, and management of COVID-19 infection in vulnerable patients with pre-existing liver injury. This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.

Keywords: COVID-19; Inflammation; Liver injury; Management; SARS-CoV-2.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Immune homeostasis is disrupted by psychological stress in patients with severe coronavirus disease 2019. ALT: Alanine aminotransferase; AST: Serum aspartate aminotransferase; COVID-19: Coronavirus disease 2019; CRP: C-reactive protein; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
The key role of antiviral drugs targeting coronavirus disease 2019 in liver dysfunction. COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.
Figure 3
Figure 3
Severe inflammatory response, anoxia, drug-induced liver injury, direct cytotoxicity, and reactivation of pre-existing liver disease might be the etiologic mechanisms behind liver injury in coronavirus disease 2019 patients. Cyps; Cytochrome P450; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

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