Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.

Keywords: Coronavirus disease 2019; Intensive care unit; Liver disease; Liver unit; Prealbumin; Severe acute respiratory syndrome coronavirus 2.

Figure 1

Proposed approach to liver disease in critically ill patients with coronavirus disease 2019. Apart from general rules regarding all patients, special measures can help clinicians identify and confront liver disease in severely ill patients with coronavirus disease 2019. ALI: Acute liver injury; ALT: Alanine aminotransferase; APRI: Aspartate aminotransferase to platelet ratio index; AST: Aspartate aminotransferase; COVID-19: Coronavirus disease 2019; FIB-4: Fibrosis-4; GGT: Gamma-glutamyl transpeptidase; HBV: Hepatitis B virus; ICU: Intensive care unit; LFTs: Liver function tests; NFS: Nonalcoholic fatty liver disease fibrosis score; POCUS: Point-of-care ultrasonography; UDCA: Ursodeoxycholic acid.