Hepatic Disorders and COVID-19: From Pathophysiology to Treatment Strategy

Abstract

Following the SARS-CoV-2 outbreak and the subsequent development of the COVID-19 pandemic, organs such as the lungs, kidneys, liver, heart, and brain have been identified as priority organs. Liver diseases are considered a risk factor for high mortality from the COVID-19 pandemic. Besides, liver damage has been demonstrated in a substantial proportion of patients with COVID-19, especially those with severe clinical symptoms. Furthermore, antiviral medications, immunosuppressive drugs after liver transplantation, pre-existing hepatic diseases, and chronic liver diseases such as cirrhosis have also been implicated in SARS-CoV-2-induced liver injury. As a result, some precautions have been taken to prevent, monitor the virus, and avoid immunocompromised and susceptible individuals, such as liver and kidney transplant recipients, from being infected with SARS-CoV-2, thereby avoiding an increase in mortality. The purpose of this review was to examine the impairment caused by SARS-CoV-2 infection and the impact of drugs used during the pandemic on the mortality range and therefore the possibility of preventive measures in patients with liver disease.

Liver Damage and COVID-19: At Least a “Two-Hit” Story in Systematic Review

“…Less frequently, we can find higher values of total and direct bilirubin and reduced values of synthetic liver capability (e.g., reduced total albumin values and higher prothrombin time). These findings do not differ between men and women with COVID-19 [ 11 ].…”

“…However, increased AST and ALP levels are significantly and specifically associated with COVID-19 liver injury vs. derangement of ALT and total bilirubin values [ 9 , 10 , 11 ].…”

“…In detail, immunosuppressants (e.g., tocilizumab and dexamethasone) have been first linked to DILI cases [ 9 , 10 , 11 ]. In fact, COVID-19 patients treated with tocilizumab reported serum transaminases increased by 40-fold, eventually resolved within 10 days [ 56 ].…”

“…It is well-recognized that liver transplant recipients are more vulnerable to SARS-CoV-2 infection and have a higher potential for virus shedding. In fact, liver-transplanted patients account for almost 4 million individuals because liver transplantation is the world’s second most prevalent solid organ transplant [ 11 ]. Although there is the potential for virus passage from donor to recipient, the molecular mechanism of this passage has not yet been discovered.…”

“…Usually, this rise is mild and self-limiting. In a few cases, acute liver failure starts and can overlap with drug-induced liver damage and pre-existing chronic liver diseases [ 10 , 11 ].…”