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Review
. 2022 Jul 14;14(7):e26852.
doi: 10.7759/cureus.26852. eCollection 2022 Jul.

A Systematic Review of SARS-CoV-2-Associated Hepatic Dysfunction and the Impact on the Clinical Outcome of COVID-19

Aleksandra Radivojevic  1 , Anas A Abu Jad  2 , Anvesh Ravanavena  1 , Chetna Ravindra  3 , Emmanuelar O Igweonu-Nwakile  1 , Safina Ali  4 , Salomi Paul  4 , Shreyas Yakkali  4 , Sneha Teresa Selvin  1 , Sonu Thomas  4 , Viktoriya Bikeyeva  1 , Ahmed Abdullah  1 , Prachi Balani  1
Affiliations
Review

A Systematic Review of SARS-CoV-2-Associated Hepatic Dysfunction and the Impact on the Clinical Outcome of COVID-19

Aleksandra Radivojevic et al. Cureus. .

Abstract

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe since December 2019. The spectrum of clinical manifestations of COVID-19 ranges from mild to life-threatening forms. Alteration of hepatic function in COVID-19 is multifactorial. The objective of this systematic review is to assess the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced hepatic dysfunction and the clinical outcome in patients infected with COVID-19. We methodically explored several electronic databases (PubMed, PubMed Central, MEDLINE, and Google Scholar) in April 2022 using focused words and terms of medical subject headings for appropriate studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting our systematic review. Hepatic dysfunction was identified as elevation of liver function tests (LFTs) above the upper limit of normal. The clinical outcome was described as a combination of mortality, intensive care unit (ICU) transfer, and the need for mechanical ventilation (MV). The initial search yielded a total of 7187 studies. After elimination of duplicates, exclusion of studies based on irrelevant titles and abstracts, comprehensive analysis of full-text formats, and evaluation of quality, a total of 16 studies were eligible to be included in our systematic review. In the 16 selected studies, there were 23,962 patients. The SARS-CoV-2 virus can negatively affect several organ systems by interacting with specific receptors widely expressed in the human body. A multifactorial etiology of hepatic dysfunction is observed in COVID-19. SARS-CoV-2 infection is associated with abnormal LFTs. Significantly higher mortality, ICU admissions, and requirement for MV are associated with LFT alterations. For this reason, patients infected with COVID-19 must have their hepatic function closely monitored.

Keywords: coronavirus disease 2019; covid-19; liver; liver failure; liver function tests; liver injury; sars-cov-2; transaminases.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart presenting study selection strategy
PMC: PubMed Central.
Figure 2
Figure 2. Schematic demonstration of COVID-19 pathophysiology
ACE2R: angiotensin-converting enzyme 2 receptors; TNF-alpha: tumor necrosis factor-alpha; IL: interleukin; ARDS: acute respiratory distress syndrome.
Figure 3
Figure 3. Possible mechanisms of hepatic damage in patients infected with SARS-CoV-2 virus
ACE2: angiotensin-converting enzyme 2.
See this image and copyright information in PMC

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References

    1. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Zhou F, Yu T, Du R, et al. Lancet. 2020;395:1054–1062. - PMC - PubMed
    1. WHO coronavirus (COVID-19) dashboard. [ Apr; 2022 ];World Health Organization. https://covid19.who.int/ WHO. 2022
    1. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. Young BE, Ong SW, Kalimuddin S, et al. JAMA. 2020;323:1488–1494. - PMC - PubMed
    1. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. [PREPRINT] Chai X, Hu L, Zhang Y, et al. BioRxiv. 2020
    1. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Zhou P, Yang XL, Wang XG, et al. Nature. 2020;579:270–273. - PMC - PubMed

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