COVID-19-induced transaminitis and hyperbilirubinemia: Presentation and outcomes

Abstract

The risk of liver injury in patients with coronavirus disease 2019 (COVID-19) infection is quite evident. Furthermore, liver function test abnormalities are still detected in COVID-19 patients despite the development of antivirals and the availability of several types of vaccines. This editorial describes liver involvement during COVID-19 infection in patients with or without preexisting liver injury, such as chronic liver disease, to elucidate COVID-19-induced liver function abnormalities and their severity, pathophysiology, clinical manifestations, and clinical and laboratory outcomes. We also discuss the effect of vaccination against COVID-19 to better understand host factors, such as age, gender, and race, on the incidence and severity of liver dysfunction at initial presentation and during the illness. Finally, we summarize the results of relevant meta-analyses published to date and highlight the importance of adequate liver function monitoring in the current climate of the overwhelming COVID-19 pandemic.

Keywords: COVID-19; Hyperbilirubinemia; Liver injury; Pathophysiology; SARS-CoV-2; Transaminases.

Figure 1

Summary of coronavirus disease 2019-induced liver dysfunction. MAFLD: Metabolic-associated fatty liver disease; AILD: Autoimmune liver diseases; COVID-19: Coronavirus disease 2019; ALT: Alanine transaminase; ULN: Upper limit of normal; AST: Aspartate transaminase; PICU: Pediatric intensive care; CLD: Chronic liver disease; HELLP: Hemolysis, elevated liver enzymes and low platelet; MISC: Multisystem inflammatory syndrome of children.