COVID-19 and the liver: little cause for concern

Bangash, Mansoor N.; Patel, Jaimin; Parekh, Dhruv

doi:10.1016/s2468-1253(20)30084-4

Cited by 440 publications

(495 citation statements)

References 10 publications

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“…However, published data suggest that admitted patients with COVID-19 have liver abnormalities without mechanical ventilation. Furthermore, the distribution of aminotransferase levels among patients with COVID-19 does not support hypoxic hepatitis being common [30]. Importantly, drug-induced liver injury during COVID-19 treatment should be carefully investigated.…”

Section: Covid-19 and The Livermentioning

confidence: 99%

Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now?

Musa

2020

Arab Journal of Gastroenterology

148

182

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Section: Covid-19 and The Livermentioning

confidence: 99%

Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now?

Musa

2020

Arab Journal of Gastroenterology

148

182

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“…32 However, this hypothesis has been contested by some authors since the derangement of liver function is usually mild and there is no evidence that late-onset symptoms are associated with greater liver function damage. 33 Some systemic viral infections, such as Epstein-Barr virus, cytomegalovirus, herpes simplex virus, parvovirus and adenovirus, are associated with similar elevations of liver function biomarkers which reflect immune activation and inflammation caused by circulating cytokines. 34 Furthermore, few studies reported higher serum pro-inflammatory cytokines and chemokines levels in patients with abnormal liver function compared to those with normal liver function.…”

Section: Covid -19 and Hepati C Inj Urymentioning

confidence: 99%

“…Lastly, some authors suggest that drug-induced liver injury is also a possible contributing factor to laboratory test abnormalities. 33,36 Liver injury may occur after the use of multiple drugs, such as antivirals, antibiotics, traditional Chinese medicine, antipyretics and analgesics. 7,10 Although liver histology is poorly accessible in COVID-19, few studies have already reported pathological findings on autopsies performed on SARS-CoV-2 infected patients.…”

Section: Covid -19 and Hepati C Inj Urymentioning

confidence: 99%

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

Garrido

Liberal

Macedo

2020

Aliment Pharmacol Ther

165

187

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SummaryBackgroundSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the causative pathogen of coronavirus disease 2019 (COVID‐19), became a global threat to human health. Liver impairment has been frequently reported as a common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver disease (CLD).AimsTo summarise the changes in liver function tests during SARS‐CoV‐2 infection and the impact of COVID‐19 in patients with underlying CLD.MethodsA literature review using online database PubMed was done using the search terms “SARS‐CoV‐2”, “COVID‐19”, “liver”, “cirrhosis” and “liver transplantation”.ResultsCOVID‐19 is frequently associated with different degrees of abnormal liver function tests, most notably transaminases, which are usually transitory and of mild degree. Available evidence suggests that liver injury may result from direct pathogenic effect by the virus, systemic inflammation or toxicity from commonly used drugs in this subset of patients. SARS‐CoV‐2 infection in children is associated with minimal or no increase in liver enzymes, thus the presence of abnormal liver function tests should trigger evaluation for underlying liver diseases. Although it seems that patients with CLD are not at greater risk for acquiring the infection, those with cirrhosis, hepatocellular carcinoma, non‐alcoholic fatty liver disease, autoimmune liver diseases or liver transplant may have a greater risk for severe COVID‐19.ConclusionsAbnormal liver function tests during the course of COVID‐19 are common, though clinically significant liver injury is rare. Further research is needed focusing on the effect of existing liver‐related comorbidities on treatment and outcome of COVID‐19.

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“…Recent clinical studies of COVID-19 indicate that hepatic injury presents with elevated transaminases, elevated bilirubin, prolonged prothrombin time and hypoproteinemia [9] and the severity of blood test anomalies may predict a poorer outcome. Bangash et al reported that mild laboratory anomalies were not prognostic of outcomes [10]; however, 58% to 78% of patients with severe COVID-19 associated disease presented with varying degrees of liver injury [11], therefore clinically significant liver dysfunction may be an important feature of and may predict the prognosis of COVID-19 [2,9,12]. The pathogenesis is likely multifactorial including: (i) viral hepatitis (hepatic viral replication); (ii) hypoxic hepatitis (secondary to respiratory failure); (iii) hepatic congestion associated with mechanical ventilation (high levels of positive end-expiratory pressure (PEEP)); (iv) drug toxicity (antiviral medications, anti-malaria medications, antibiotics, steroids); (v) immune response (virally induced intrahepatic cytotoxic T cells and Kupffer cells) and (vi) gut vascular barrier and microbiota alterations [10].…”

Section: Introductionmentioning

confidence: 99%

COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

Kukla

Skonieczna-Żydecka

Kotfis

et al. 2020

JCM

100

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The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.

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COVID-19 and the liver: little cause for concern

Cited by 440 publications

References 10 publications

Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now?

Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now?

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

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