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Review
. 2022 Oct:154:113568.
doi: 10.1016/j.biopha.2022.113568. Epub 2022 Aug 17.

COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

Penghui Li  1 , Ying Liu  1 , Ziqi Cheng  1 , Xiaorui Yu  1 , Yinxiong Li  2
Affiliations
Review

COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

Penghui Li et al. Biomed Pharmacother. 2022 Oct.

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global epidemic and poses a major threat to public health. In addition to COVID-19 manifesting as a respiratory disease, patients with severe disease also have complications in extrapulmonary organs, including liver damage. Abnormal liver function is relatively common in COVID-19 patients; its clinical manifestations can range from an asymptomatic elevation of liver enzymes to decompensated hepatic function, and liver injury is more prevalent in severe and critical patients. Liver injury in COVID-19 patients is a comprehensive effect mediated by multiple factors, including liver damage directly caused by SARS-CoV-2, drug-induced liver damage, hypoxia reperfusion dysfunction, immune stress and inflammatory factor storms. Patients with chronic liver disease (especially alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma) are at increased risk of severe disease and death after infection with SARS-CoV-2, and COVID-19 aggravates liver damage in patients with chronic liver disease. This article reviews the latest SARS-CoV-2 reports, focusing on the liver damage caused by COVID-19 and the underlying mechanism, and expounds on the risk, treatment and vaccine safety of SARS-CoV-2 in patients with chronic liver disease and liver transplantation.

Keywords: COVID-19; Chronic liver disease; Liver injury; Liver transplant; SARS-CoV-2; Vaccine.

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Conflict of interest statement

Conflict of interest statement All authors declare that they have no competing interests.

Figures

ga1
Graphical abstract
Fig. 1
Fig. 1
Mechanisms of COVID-19-associated liver injury. (1) Drug-induced liver injury; (2) SARS-CoV-2 directly damages the liver; (3) hypoxia ischemia reperfusion injury; and (4) immune stress and inflammatory factor storms.
Fig. 2
Fig. 2
Outcomes of COVID-19 in patients with chronic liver disease.
Fig. 3
Fig. 3
Mortality after SARS-CoV-2 infection in patients with cirrhosis (by the Child–Pugh score).
Fig. 4
Fig. 4
Recommendations for COVID-19 vaccination in patients with liver disease.
See this image and copyright information in PMC

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