Liver dysfunction as a cytokine storm manifestation and prognostic factor for severe COVID-19

Abstract

Liver damage in severe acute respiratory coronavirus 2 infection occurs in patients with or without preexisting liver disorders, posing a significant complication and mortality risk. During coronavirus disease 2019 (COVID-19), abnormal liver function is typically observed. However, liver injury may occur because of the treatment as well. Ischemia, cytokine storm, and hypoxia were identified as the three major factors contributing to liver damage during COVID-19. Indeed, raised liver enzymes during hospitalizations may be attributed to medications used, as well as sepsis and shock. As a result, the proportion of hospitalized patients afflicted with COVID-19 and pathological liver biomarkers varies from 14% to 53%. Aminotransferases and bilirubin are found most often elevated. Usually, increased gamma-glutamyltransferase, alkaline phosphatase, and decreased serum albumin levels are demonstrated. Additionally, although there is no specific treatment for COVID-19, many of the drugs used to treat the infection are hepatotoxic. In this mini-review, we focus on how liver dysfunction can be one of the features associated with the COVID-19 cytokine storm. Furthermore, data show that liver injury can be an independent predictor of severe COVID-19, the need for hospitalization, and death.

Keywords: Alanine aminotrans-ferase; Aspartate aminotransferase; Bilirubin; COVID-19; Cytokine storm; Interleukin-6; Liver damage; Liver dysfunction; Prognostic factor; SARS-CoV-2; Severe COVID-19.

Figure 1

Liver dysfunction defined by the negative effects of cytokine storm (severe inflammation, thrombosis, hypoxia, etc.) during coronavirus disease 2019 infection. Other contributing factors for liver injury are also presented – preexisting liver condition, direct cytopathic action of severe acute respiratory coronavirus 2 and treatment with hepatotoxic drugs.