Hepatic Injury in Patients With COVID-19

Abstract

Background: Coronavirus disease 2019 (COVID-19) has infected over 2 million people worldwide over the course of just several months. Various studies have highlighted that patients infected with COVID-19 may develop various degrees of liver injury. Here, we discuss the impact of underlying liver disease and manifestations of hepatic injury with COVID-19. We also review mechanisms of hepatic injury. Methods: We searched the database PubMed for all studies focused on hepatic injury in COVID-19. Results: We identified 13 studies that assessed the impact of underlying liver disease in patients infected with COVID-19 (N=3046). Underlying liver disease was one of the most common known comorbid categories in patients infected with COVID-19. Overall, 25% of the patients identified from the 13 studies had hepatic injury. Twenty-one percent and 24% had elevated alanine transaminase and aspartate transaminase values, respectively. Nine percent of the patients had elevated total bilirubin values. Ten of the 13 studies assessed COVID-19 acuity with severity of hepatic injury. In 9 of the 10 studies, clinical outcomes were worse with hepatic injury. Conclusions: Liver injury is highly prevalent in patients that present with COVID-19. Since the liver is one of the most affected organs outside of the respiratory system in COVID-19, more intensive surveillance is warranted for severe cases, particularly among those with pre-existing advanced liver disease.

Altered gut microbial metabolites could mediate the effects of risk factors in Covid‐19

“…Simple hepatic steatosis and non‐alcoholic steatohepatitis may also need to be distinguished as pre‐existing inflammatory conditions could be important in the severity of Covid‐19. A recent meta‐analysis confirmed that liver injury was common in Covid‐19, reaching 25%, with a worsening clinical outcome 130 …”

“…It also increases antimicrobial peptide expression and gut barrier integrity 139 . Increased expression of antimicrobial peptides by vitamin D in the respiratory tract protects the lungs from viral infections 130 . Vitamin D in combination with magnesium and vitamin B12 are able to reduce oxygen support and intensive care in Covid‐19 131 .…”

Elevations in Liver Transaminases in COVID-19: (How) Are They Related?

“…Gastrointestinal symptoms have been described to occur up to 15% (4), and were attributed to viral cell invasion mediated by Angiotensin-Converting Enzyme 2 (ACE2) receptors at the enterocyte level (5). Although not fully understood, the involvement of the liver with elevated levels of hepatic enzymes in blood biochemistry tests has also been described to occur in 14-53% of the cases (6)(7)(8)(9)(10). Possible mechanisms that may be associated with liver damage during COVID-19 are (1) an immune-mediated inflammation; (2) a direct cytotoxic effect caused by viral replication of hepatocytes; (3) a drug-induced liver injury, including self-prescribing medications and those used for the treatment of COVID-19, such as remdesivir, tocilizumab, chloroquine; and (4) reactivation of previously existing liver diseases (11,12).…”

Bilirubin Levels as Potential Indicators of Disease Severity in Coronavirus Disease Patients: A Retrospective Cohort Study

“…However, COVID-19 patients frequently show evidence of damage to other organs. Furthermore, those with pre-existing liver disease or newly occurred evidence of liver injury have an increased likelihood of a poor prognosis (5,6). A number of studies have suggested that liver disease is one of the most common comorbidities of COVID-19 patients and a number of patients infected with SARS-CoV-2 can develop different degrees of liver injury (7,8).…”