Liver Injury in Patients with COVID-19 without Underlying Liver Disease

Abstract

SARS-CoV-2 shows a high affinity for the ACE-2 receptor, present on the epithelial cells of the upper and lower respiratory tract, within the intestine, kidneys, heart, testes, biliary epithelium, and—where it is particularly challenging—on vascular endothelial cells. Liver involvement is a rare manifestation of COVID-19. Material and Methods: We reviewed 450 patients admitted due to the fact of SARS-CoV-2 infection (COVID-19) including 88 with liver injury. Based on medical history and previous laboratory test results, we excluded cases of underlying liver disease. The analysis involved a clinical course of COVID-19 in patients without underlying liver disease as well as the type and course of liver injury. Results: Signs and symptoms of liver injury were present in 20% of patients, mostly presenting as a mixed-type pattern of injury with less common cases of standalone hepatocellular (parenchymal) or cholestatic injury. The liver injury symptoms resolved at the end of inpatient treatment in 20% of cases. Sixteen patients died with no cases where liver injury would be deemed a cause of death. Conclusions: (1) Liver injury secondary to COVID-19 was mild, and in in 20%, the signs and symptoms of liver injury resolved by the end of hospitalization. (2) It seems that liver injury in patients with COVID-19 was not associated with a higher risk of mortality. (3) The underlying mechanism of liver injury as well as its sequelae are not fully known. Therefore, caution and further monitoring are advised, especially in patients whose liver function tests have not returned to normal values.

Acute hepatitis with portal and mesenteric vein thrombosis revealing SARS-CoV-2 infection: Case report and literature review

“…Some studies have mentioned that impaired liver perfusion is secondary to microvascular thrombosis, mitochondrial dysfunction, and hepatic steatosis induced by SARS-CoV-2 that targets the liver [ 16 ]. Therefore, this can be origin of raised levels of AST which is elevated relative to ALT, showing an AST/ALT ratio >1 [ 17 ].…”

Liver Injury and Severe Covid 19 Associated without Prior Liver Disease

“…Results from this study were in line with those from earlier ones. [21,22] Since high blood pressure is a common comorbidity, medication history may have a role in increasing abnormal liver enzyme levels. Pre-admission, 27 percent of patients were taking diuretics, 25 percent were on ACE inhibitors, 31 percent were using beta-blockers, and the rest were taking statins (16.4 percent ).…”

Liver Function Tests in COVID-19: Assessment of the Actual Prognostic Value

“…They showed a predominance of parenchymal liver injury based on the prevalence of elevated AST and ALT [ 21 ]. Studies considering liver biochemistry at baseline seem to confirm this tendency [ 22 , 23 ]. Significant elevations in ALP are uncommonly recorded despite strong cholangiocyte ACE2 expression, with mildly raised GGT levels seen in up to 50% of patients [ 7 , 22 , 23 , 24 ].…”

“…Studies considering liver biochemistry at baseline seem to confirm this tendency [ 22 , 23 ]. Significant elevations in ALP are uncommonly recorded despite strong cholangiocyte ACE2 expression, with mildly raised GGT levels seen in up to 50% of patients [ 7 , 22 , 23 , 24 ]. Nevertheless, the clinical significance of these observations remains inconclusive.…”