COVID‐19 and hepatic involvement: The liver as a main actor of the pandemic novel

Napodano, Cecilia; Pocino, Krizia; Stefanile, Annunziata; Marino, Mariapaola; Miele, Luca; Gulli, Francesca; Basile, Valerio; Pandolfi, Franco; Gasbarrini, Antonio; Rapaccini, Gian Ludovico; Basile, Umberto

doi:10.1111/sji.12977

Cited by 24 publications

(27 citation statements)

References 50 publications

(79 reference statements)

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“…The adipose tissue of obese patients is thought to express high levels of ACE2 and, thus potentially functions as SARS‐CoV‐2 reservoir with prolonged viral shedding time 37 . SARS‐CoV‐2 infection and the related hyperinflammatory syndrome could act as “second hit” to a simple fatty liver and trigger “acute‐on‐chronic” steatohepatitis (NASH) with elevated aminotransferases 34 . Moreover, hepatic expression of ACE2 was strongly upregulated in a high‐fat diet‐induced NASH model in rodents, 16 possibly increasing hepatic susceptibility to SARS‐CoV‐2 infection in patients with NAFLD or NASH.…”

Section: Covid‐19 In Patients With Pre‐existing Liver Diseasementioning

confidence: 99%

“…Individuals with a poorer prognosis of COVID-19 are typically older (>60) with metabolic co-morbidities such as obesity (body mass index >30 kg/m 2 ) and diabetes, a profile which is similar to those at increased risk of NAFLD. 33,34 A study from 2 COVID-19 hospitals in China compared liver function tests and clinical outcome in patients with (n = 47) and without (n = 155) NAFLD.…”

Section: Obesity and Non-alcoholic Fatty Liver Disease (Nafld)mentioning

confidence: 99%

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COVID‐19 and the liver – Lessons learned

Herta

Berg

2021

Liver International

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Liver involvement, indicated by elevated liver function test results, is common in hospitalized patients with coronavirus disease 2019 (COVID‐19) and has been linked to disease severity and outcome. A dual pattern of elevated liver function tests can be observed especially in patients with severe or critical COVID‐19, characterized by an increase in aminotransferases early in the course of this disease, followed by an increase in cholestasis‐associated biochemistry markers at later stages. This dual pattern is associated with inflammatory response markers and poor outcome. Current notions on the mechanisms of liver injury in COVID‐19 include direct cytopathic effects of the virus on hepatocytes and cholangiocytes, ischemic and hypoxic liver damage, drug‐induced liver injury, activation of hepatic immune cells by excess cytokine production and exacerbation of pre‐existing liver disease. Patients with obesity‐related non‐alcoholic fatty liver disease and, in particular, patients with cirrhosis are at high risk of liver injury and a fatal outcome from COVID‐19. In contrast, individuals receiving stable immunosuppressive medication for autoimmune liver diseases or during long‐term follow‐up after liver transplantation do not have a higher case‐to‐infection ratio and have a fairly favourable outcome. The present review describes the epidemiology, characteristics and potential pathological mechanisms of COVID‐19‐related liver injury. Moreover, the influence of pre‐existing liver disease on the susceptibility and severity of liver injury in COVID‐19 are discussed.

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Section: Covid‐19 In Patients With Pre‐existing Liver Diseasementioning

confidence: 99%

Section: Obesity and Non-alcoholic Fatty Liver Disease (Nafld)mentioning

confidence: 99%

COVID‐19 and the liver – Lessons learned

Herta

Berg

2021

Liver International

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“…Patients with COVID-19 may experience cytokine storm syndrome, with the excessive release of inflammatory mediators due to overactivation of the immune system [18]. Li et al [19] showed that elevated levels of C-reactive protein serve as a predictor of liver injury.…”

Section: Discussionmentioning

confidence: 99%

Fulminant hepatic failure in a patient testing re-positive for SARS-CoV-2: a case report

et al. 2021

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Background Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may not elicit lifelong protective immunity and reinfection could occur. Liver function impairment is a common manifestation of coronavirus disease 2019 (COVID-19). However, acute hepatic failure in the setting of COVID-19 is very rare. Case presentation We report the case of a 47-year-old woman who presented with acute abdominal pain and vomiting. Abdominal examination revealed a soft and lax abdomen with mild tenderness in the right upper quadrant. The patient recovered from COVID-19 2 months previously with negative results on reverse transcription-polymerase chain reaction (RT-PCR). Laboratory investigations revealed markedly elevated transaminases with normal results on viral hepatitis serology panel and undetectable blood paracetamol level. Prior to admission, the patient underwent RT-PCR for SARS-CoV-2, which revealed a positive result. The patient experienced rapid deterioration in the neurological status with a remarkable increase in the liver enzyme levels. Despite aggressive resuscitation, the patient suffered irreversible cardiac arrest and died. Conclusion Fulminant hepatic failure is a rare manifestation in patients with re-positive RT-PCR tests for SARS-CoV-2. Clinicians should maintain a high index of suspicion for hepatic injury with active monitoring of liver enzymes.

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“…The ubiquitous distribution of SARS-COV-2 receptor for viral entry, ACE2, on Cholangiocytes naturally points towards a hepatic injury being a common systemic manifestation of extrapulmonary COVID-19 infection 12 . Possible mechanisms that may potentially underlie this association include immune-mediated damage as a result of the severe inflammatory response commonly referred to as "the cytokine storm" 13 , direct hepatotoxicity due to viral replication in hepatic cells, anoxic damage (hypoxic hepatitis) that may accompany respiratory failure, Drug-induced liver injury (DILI) and the reactivation of a pre-existing liver disease [14][15][16] .…”

Section: Discussionmentioning

confidence: 99%