2020
DOI: 10.6061/clinics/2020/e2250
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COVID-19 and Liver Damage: Narrative Review and Proposed Clinical Protocol for Critically ill Pediatric Patients

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Cited by 14 publications
(23 citation statements)
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“…13,17,18,21 The E-ALT mechanism in SARS-CoV-2 is not fully understood, but under investigation are an effect of viral lesions in hepatic/cholangiocyte cells, inflammatory damage, hypoxic/shock-related circulatory compromise, endothelial dysfunction, microthrombi formation, and drug toxicity. [22][23][24] The direct viral cytopathic effect in the pathophysiology of E-ALT via the cell receptors for angiotensin-converting enzyme II and transmembrane protease serine 2, invoked in the transmission of SARS-CoV-2, is supported by the demonstration of SARS-CoV-2 in the liver parenchyma in patients with higher liver enzyme elevation. 25 As previously reported, children with E-ALT in the COVID-19 cohort more frequently carried an underlying medical condition such as immunocompromised state (including malignancy), or CLD, significantly contrasting with those with E-ALT in MIS-C. 3,4,26 In our study, although children with MIS-C had >2× higher odds of any degree of elevation in ALT levels compared to children with COVID-19 (51% vs 31%), severe elevation, defined as ALT >200 U/L was observed at a higher frequency in children with COVID-19 (8% vs 4%) (Figure 1).…”
Section: Discussionmentioning
confidence: 99%
“…13,17,18,21 The E-ALT mechanism in SARS-CoV-2 is not fully understood, but under investigation are an effect of viral lesions in hepatic/cholangiocyte cells, inflammatory damage, hypoxic/shock-related circulatory compromise, endothelial dysfunction, microthrombi formation, and drug toxicity. [22][23][24] The direct viral cytopathic effect in the pathophysiology of E-ALT via the cell receptors for angiotensin-converting enzyme II and transmembrane protease serine 2, invoked in the transmission of SARS-CoV-2, is supported by the demonstration of SARS-CoV-2 in the liver parenchyma in patients with higher liver enzyme elevation. 25 As previously reported, children with E-ALT in the COVID-19 cohort more frequently carried an underlying medical condition such as immunocompromised state (including malignancy), or CLD, significantly contrasting with those with E-ALT in MIS-C. 3,4,26 In our study, although children with MIS-C had >2× higher odds of any degree of elevation in ALT levels compared to children with COVID-19 (51% vs 31%), severe elevation, defined as ALT >200 U/L was observed at a higher frequency in children with COVID-19 (8% vs 4%) (Figure 1).…”
Section: Discussionmentioning
confidence: 99%
“…Therefore, the pathophysiology of the liver involvement in COVID-19 and MIS-C is still unclear, but it is believed that the injury might be caused by hepatocellular infection with direct cytopathic effects of SARS-CoV-2 or an immune-mediated response with inflammatory damage. In addition, hypoxic/shock-related circulatory compromise, endothelial dysfunction, microthrombi formation and drug-induced liver injury (e.g., corticosteroids, lopinavir, ritonavir, tocilizumab and remdesivir) may be involved [ 12 ]. COVID-19-associated liver injury is defined as any liver damage occurring during disease course and treatment of COVID-19 patients, with or without pre-existing liver disease [ 13 ] and typically leads to a temporary moderate elevation of liver tests without significant hepatic synthetic function impairment.…”
Section: Discussionmentioning
confidence: 99%
“…Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is a systemic disease, responsible of a variety of clinical manifestations, affecting not only upper and lower respiratory tract but also gastrointestinal system and liver 1 . Small case series have reported hepatic involvement in up to 60% of infected patients, especially in severe and critical cases of coronavirus disease 2019 (COVID‐19) 1,2 . In children aged 0–3 years, transient mild elevation in serum aminotransferases is common during symptomatic phase, with an overall prevalence of approximately 29% 3 .…”
Section: Introductionmentioning
confidence: 99%