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. 2022 Jan 8;11(2):308.
doi: 10.3390/jcm11020308.

Liver Injury in Patients with COVID-19 without Underlying Liver Disease

Monika Pazgan-Simon  1   2 , Sylwia Serafińska  1   2 , Michał Kukla  3   4 , Marta Kucharska  1   2 , Jolanta Zuwała-Jagiełło  5 , Iwona Buczyńska  2 , Kamila Zielińska  2 , Krzysztof Simon  1   2
Affiliations

Liver Injury in Patients with COVID-19 without Underlying Liver Disease

Monika Pazgan-Simon et al. J Clin Med. .

Abstract

SARS-CoV-2 shows a high affinity for the ACE-2 receptor, present on the epithelial cells of the upper and lower respiratory tract, within the intestine, kidneys, heart, testes, biliary epithelium, and-where it is particularly challenging-on vascular endothelial cells. Liver involvement is a rare manifestation of COVID-19.

Material and methods: We reviewed 450 patients admitted due to the fact of SARS-CoV-2 infection (COVID-19) including 88 with liver injury. Based on medical history and previous laboratory test results, we excluded cases of underlying liver disease. The analysis involved a clinical course of COVID-19 in patients without underlying liver disease as well as the type and course of liver injury.

Results: Signs and symptoms of liver injury were present in 20% of patients, mostly presenting as a mixed-type pattern of injury with less common cases of standalone hepatocellular (parenchymal) or cholestatic injury. The liver injury symptoms resolved at the end of inpatient treatment in 20% of cases. Sixteen patients died with no cases where liver injury would be deemed a cause of death.

Conclusions: (1) Liver injury secondary to COVID-19 was mild, and in in 20%, the signs and symptoms of liver injury resolved by the end of hospitalization. (2) It seems that liver injury in patients with COVID-19 was not associated with a higher risk of mortality. (3) The underlying mechanism of liver injury as well as its sequelae are not fully known. Therefore, caution and further monitoring are advised, especially in patients whose liver function tests have not returned to normal values.

Keywords: SARS-CoV-2 infection; cholestasis; liver injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) ALT activity: second measurement (seven days after admission) in patients with parenchymal and mixed liver injury. First component: COVID-19 survivors. Second component: patients who eventually died of COVID-19. (b) AST activity: second measurement (seven days after admission) in patients with parenchymal and mixed liver injury. First component: COVID-19 survivors. Second component: patients who eventually died of COVID-19.
See this image and copyright information in PMC

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