COVID-19: Has the Liver Been Spared?

Abstract

The liver is a secondary and often collateral target of COVID-19 disease but can lead to important consequences. COVID-19 might directly cause a high number of complications in patients with pre-existing chronic liver disease, increasing their risk of hepatic decompensation. Moreover, it also determines indirect consequences in the management of patients with liver disease, especially in those suffering from decompensated cirrhosis and HCC, as well as in the execution of their follow-up and the availability of all therapeutic possibilities. Liver imaging in COVID-19 patients proved to be highly nonspecific, but it can still be useful for identifying the complications that derive from the infection. Moreover, the recent implementation of telemedicine constitutes a possible solution to both the physical distancing and the re-organizational difficulties arising from the pandemic. The present review aims to encompass the currently hypothesized pathophysiological mechanisms of liver injury in patients with COVID-19 mediated by both the direct invasion of the virus and its indirect effects and analyze the consequence of the pandemic in patients with chronic liver disease and liver tumors, with particular regard to the management strategies that have been implemented to face this worldwide emergency and that can be further improved.

Impact of COVID-19 on 1-Year Survival Outcomes in Hepatocellular Carcinoma: A Multicenter Cohort Study

“…All areas of HCC management [ 13 ] were impacted, with the suspension of surveillance programs and reduced access to surgical and interventional radiology for cancer treatment, alongside a recommendation that oral tyrosine kinase inhibitors could be considered for all stages of HCC, given that the tablets could be delivered by courier, alleviating the need and risk of attending hospital [ 14 , 15 ]. These changes reflect the rapid reorganisation of hospital activities to minimise patient exposure to SARS-CoV-2 as much as possible, whilst maintaining clinical outcomes [ 16 ]. Adoption of guidance regarding kinase inhibitors was confirmed by our study, with these prescribed across all BCLC stages, with no delays seen in the delivery of systemic therapy.…”

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…To date, the number of investigations dedicated to this problem is highly limited, so further explorations are required [228,229]. Nevertheless, the analysis of individuals with non-cirrhotic CLD indicated ALD as the state predisposing to increased mortality [230,231].…”

Unraveling the Molecular and Cellular Pathogenesis of COVID-19-Associated Liver Injury

“…COVID-19 may increase the risk of hepatic decompensation by directly causing many complications in patients with CLD. Furthermore, it also affects indirect outcomes in the management of patients with CLD, particularly in those having decompensated cirrhosis and HCC [ 109 ]. Patients with cirrhosis have an increased risk of liver decompensation and acute-on-chronic liver failure (ACLF) following viral infection, such as influenza [ 110 ].…”

“…Historic trials have revealed a >30-fold increase in ACE2 expression in cirrhotic vs. healthy livers, indicating that cirrhotic patients can be uniquely susceptible to COVID-19-related hepatic dysfunction [ 26 ]. Taking all data into account, patients with CLD are not at high risk of COVID-19, but these patients are at high risk of mortality [ 109 ].…”