COVID-19 and liver disease

Abstract

Knowledge on SARS-CoV-2 infection and its resultant COVID-19 in liver diseases has rapidly increased during the pandemic. Hereby, we review COVID-19 liver manifestations and pathophysiological aspects related to SARS-CoV-2 infection in patients without liver disease as well as the impact of COVID-19 in patients with chronic liver disease (CLD), particularly cirrhosis and liver transplantation (LT). SARS-CoV-2 infection has been associated with overt proinflammatory cytokine profile, which probably contributes substantially to the observed early and late liver abnormalities. CLD, particularly decompensated cirrhosis, should be regarded as a risk factor for severe COVID-19 and death. LT was impacted during the pandemic, mainly due to concerns regarding donation and infection in recipients. However, LT did not represent a risk factor per se of worse outcome. Even though scarce, data regarding COVID-19 specific therapy in special populations such as LT recipients seem promising. COVID-19 vaccine-induced immunity seems impaired in CLD and LT recipients, advocating for a revised schedule of vaccine administration in this population.

Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma

“…It is also known that during the COVID-19 disease there is a ‘cytokine storm’ with high levels of the proinflammatory cytokines (interleukin 1 and 6, tumor necrosis factor, etc.) whose nature is still poorly understood [ 4 ]. All these mechanisms involved in liver injuries during COVID-19 infection suggest that it is probably multifactorial damage, including vascular damage, DILI, coagulopathy, a direct cytopathic effect of the virus, as well as an exaggerated systemic immune response [ 4 ].…”

“…whose nature is still poorly understood [ 4 ]. All these mechanisms involved in liver injuries during COVID-19 infection suggest that it is probably multifactorial damage, including vascular damage, DILI, coagulopathy, a direct cytopathic effect of the virus, as well as an exaggerated systemic immune response [ 4 ]. The main biochemical abnormality detected is an elevation in aminotransferase levels, often mild, observed in more than 20% of cases, with a subsequent minimal increase in bilirubin levels (10% of patients), while the increase in gamma-glutamyl transferase and alkaline phosphatase is uncommon [ 2 , 5 ].…”

Hepatitis of unknown etiology in children: What we know and what we can do?

“…Even though transaminase elevation is common during COVID-19, severe acute liver injury is relatively rare. A “cytokine storm,” which is characterized by the release of a large number of inflammatory factors, plays a vital part in the pathophysiological of SARS-CoV-2 infection ( Dufour et al, 2022 ). With a deeper investigation and understanding of COVID-19, several studies found that the activation and proliferation of a memory T-cell pool against SARS-CoV-2 contribute to rapid viral clearance during viral reinfection ( Shah et al, 2020 ; Jung et al, 2021 ; Wang et al, 2021 ).…”

COVID-19 and liver injury: hypoalbuminaemia and γGT should be observed at hospital admission

“…In addition, while liver injury has been mostly described as mild to moderate,1 9 a severe case of liver injury has been observed by us published in this journal 10. This patient developed liver failure and, in the further course, also kidney failure with increasing bilirubin levels, coagulopathy and a peak model for end-stage liver disease score of 40.…”

“…With great interest, we read the scholarly review by Dufour et al on COVID-19 and liver disease. 1 While we commend the authors for the excellent overview, we offer a slightly different view of liver injury early during infection and would like to stress some clinically relevant features.…”