Liver Injury in Patients Hospitalized for COVID-19: Possible Role of Therapy

Abstract

Patients with COVID-19 show a high prevalence of liver injury. The pattern of this liver damage is still not fully understood. Different etiopathogenetic factors may concur; from a direct cytopathic effect, once the virus binds to the ACE-2 receptors, to the immune-mediated collateral damage, due to cytokine storm. The presence of pre-existing chronic liver disease is a contributing factor for acute organ damage during SARS-CoV2 infection. Last but not least, treatments probably play a role, also, in determining hepatotoxicity: many of the drugs we have used or are still using to treat COVID-19, combined with non-invasive ventilation, are known to sometimes determine acute liver injury. Although liver damage associated with COVID-19 is often transient and can resolve without any special treatment, it is important to understand the underlying mechanisms, particularly to better treat its more severe forms.

Keywords: COVID-19; NIV; SARS-CoV2; drugs; injury; liver.

Figure 1

(a) Suggestion of a flow chart to assess DILI in patients with COVID-19 at admission. (b) Suggestion of a flow chart to assess DILI in patients with COVID-19 during hospitalization.