Incidence, patterns, risk factors, and histopathological findings of liver injury in coronavirus disease 2019 (COVID-19): a scoping review

Abstract

Background: Coronavirus disease 2019 (COVID-19) exhibits many extrapulmonary manifestations, including liver injury. This scoping review aimed to provide insight into the incidence, patterns, risk factors, histopathological findings, and relationship with disease severity of COVID-19-associated liver injury. Furthermore, we identified existing gaps in the research on the hepatic manifestations of COVID-19 and highlighted areas for future investigations. Methods: A scoping review was conducted following the methodological framework suggested by Arksey and O'Mallay. Five online databases, along with grey literature, were searched for articles published until 22 May 2020, and we included 62 articles in the review. The research domains, methodological characteristics, and key conclusions were included in the analysis. Results: Retrospective observational studies comprised more than one third (41.9%) of the included publications, and 77.8% were conducted on living patients. The incidence of liver injury varied widely across the studies (4.8%-78%), and liver injury was frequently associated with severe COVID-19. We identified the following risk factors for liver injury: male sex, lymphopoenia, gastrointestinal involvement, old age, increased neutrophil count,

Complicações hepatobiliares em pacientes com covid-19: uma revisão integrativa

“…A bilirrubina, a fosfatase alcalina (FA) e a gama-glutamil transferase (GGT) também estão elevadas em 6 a 21% dos pacientes 2 . As elevações de ALT e AST são mais comuns na COVID-19 grave em comparação com a COVID-19 leve 3,4,5,6,7,8,9 . Isso foi comprovado por meio de um estudo que descreveu que até 78% dos casos fatais de COVID-19 apresentaram evidências clínicas de lesões hepáticas, as quais estavam relacionadas com alterações nessas enzimas 10 .…”

“…Esse quadro pode ser associado a tempestade de citocinas inflamatórias induzida pela resposta imune excessiva 22 . Além de desencadear a síndrome do desconforto respiratório agudo (SDRA) que resulta em lesões pulmonares, mas também em lesões hepáticas 27,6,7,28,8,29 .…”

“…A infecção viral das células endoteliais causa disfunção endotelial, liberação de fator VIII, fator de von Willebrand e fibrinogênio, resultando em trombose. Os achados patológicos de trombose vascular no trato gastrointestinal e no fígado sustentam a afirmação de que a hipercoagulabilidade e a trombose contribuem para as lesões hepáticas 8 .…”

“…A lesão hepática geralmente ocorre em pacientes com choque hipotensivo ou hipoxemia grave. Os vasos linfáticos estão envolvidos no processo patológico da lesão hepática aguda por meio da eliminação do vírus, absorção e transporte de exsudato produzido pela inflamação, citocinas inflamatórias, detritos de células mortas e no carreamento das células imunes, como as células T 8,27 .…”

Meta-analysis of liver injury in patients with COVID-19

“…The incidence of liver injury reported by each study varies widely. [4][5][6] This study aims to systematically analyze the published relevant studies to explore the incidence and risk factors of liver injury in COVID-19 patients, and analyze the impact of liver injury on the clinical prognosis of patients, so as to provide corresponding basis for clinical diagnosis and treatment.…”