Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease

Li, Jie; Fan, Jian Gao

doi:10.14218/jcth.2020.00019

Cited by 269 publications

(339 citation statements)

References 40 publications

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“…Patients with severe disease showed higher frequency and degree of liver dysfunction while in milder cases, the liver injury was transient [10]. The mechanisms of hepatic injury include immune-mediated in ammation, hypoxic injury due to severe pneumonia and drug related [11]. It is also postulated that expression of ACE2 receptor on cholangiocytes may predispose to cholestatic injury.…”

Section: Introductionmentioning

confidence: 99%

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

Sarin

Choudhury

Lau

et al. 2020

Preprint

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Background and Aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis. Conclusions: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.

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Section: Introductionmentioning

confidence: 99%

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

Sarin

Choudhury

Lau

et al. 2020

Preprint

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“…Liver injury has been reported by a number of studies in patients with severe COVID-19 (13)(14)(15)(16) making this organ the most commonly affected besides the respiratory system. Transient elevation of serum aminotransferases is often seen and a number of factors have been implicated for acute liver damage in severe COVID-19, including severe hypoxemia due to acute respiratory failure, drug interactions, septic shock and multiorgan dysfunction (13).…”

Section: Resultsmentioning

confidence: 99%

Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery

Ronnje

Länsberg

Vikhareva

et al. 2020

Preprint

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BackgroundIt has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infectionCase presentationA 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32+6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. ConclusionThis case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.

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“…9 Another review also summarized that liver injury has often manifested as transient elevation of serum aminotransferases, and acute liver failure has been seldom reported in the available studies. 10 In addition, the level of antithrombin, which is also a predictor of liver reserve, is maintained within normal range in most of COVID patients during most of the hospitalization, according to the study by Tang et al 5 It seems that changes of coagulation markers in COVID-19 cannot be attributed to liver failure based on current evidence.…”

Section: Laboratory Haemostasis Monitoring In Covid-19mentioning

confidence: 97%

Laboratory haemostasis monitoring in COVID‐19

Thachil

Tang

Gando

et al. 2020

Journal of Thrombosis and Haemostasis

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We agree with the authors that it is impossible to distinguish between the laboratory changes seen in patients with coagulopathy due to sepsis-induced hepatic dysfunction rather than DIC. 7 This distinction becomes particularly relevant given the data which suggest that hepatitis is present in many patients with COVID-19, being most severe in those who are critically unwell, thus mirroring the coagulopathy. 8 Further studies are necessary to look at the association between the coagulopathy and liver disease. The possibility cannot be excluded that the coagulopathy seen in COVID-19 might largely or even solely represent COVID-19 sepsis-induced hepatopathy.Finally, we must consider the very real risk of an iatrogenic anemia due to multiple blood sampling in seriously ill patients. We have an opportunity to recommend judicious testing to prevent patients with COVID-19 facing the same problem. 9The current interim guidelines [this letter refers to an earlier draft version of the Guidelines which have since been updated removing the recommendation to transfuse fibrinogen in non-bleeding patients] seem too quick to replace thorough clinical assessment with experimental biomarkers as the driver of crucial management decisions about the care of patients with COVID-19 associated coagulopathy. We feel that in times of crisis, when faced with a new and often lethal disease, clinicians must be steadfast in continuing to stress the fundamentals of thorough clinical assessment over reliance on unproven laboratory biomarkers. This challenge is a zeitgeist moment for the principles of clinical medicine-an opportunity for the reiteration of the fundamental importance of integrative clinical skills to help us in our task of providing the best clinical outcomes for people with COVID-19.

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Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease

Cited by 269 publications

References 40 publications

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery

Laboratory haemostasis monitoring in COVID‐19

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