Mechanism of Sars-Cov-2 Invasion Into the Liver and Hepatic Injury in Patients With Covid-19

Abstract

A large number of studies have shown that patients with Coronavirus disease 2019 (COVID-19) have different degrees of liver injury. However, the mechanisms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion into the liver are still not fully understood. This review mainly summarizes the recently published works on the abnormal liver biochemical indicators and the mechanism of viral invasion with liver injury in COVID-19 patients. Generally, SARS-CoV-2 infection of the liver was caused by blood circulation or retrograde infection of digestive tract, which led to the liver injury through direct cytopathic effect induced by virus or immunopathological effect caused by excessive inflammation. Besides these, hypoxia, endothelial injury and drug-induced jury were also the main reasons of liver injury in COVID-19 patients. In the liver function indicators, elevated alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, and lactate dehydrogenase levels with reduced albumin levels were observed in COVID-19 patients.

Gamma-glutamyltransferase is a strong predictor of secondary sclerosing cholangitis after lung transplantation for COVID-19 ARDS

“… 15 , 16 , 17 , 18 , 19 Several studies have shown a direct damage of SARS-COV-2 on the small bile ducts. 20 , 21 …”

Identifying Drug-Induced Liver Injury Associated With Inflammation-Drug and Drug-Drug Interactions in Pharmacologic Treatments for COVID-19 by Bioinformatics and System Biology Analyses: The Role of Pregnane X Receptor

“…Moreover, certain drugs including lopinavir/ritonavir and tocilizumab were responsible for DILI in COVID-19 patients ( Boeckmans et al, 2020 ; Olry et al, 2020 ; Zhang et al, 2020 ). Currently, liver injury induced by DPTS, related with the different PK behaviors of DPTS from those provided by drug labels and the possible adverse drug combinations, are getting concern in the management of COVID-19 ( Ali, 2020 ; Ali and Hossain, 2020 ; Ortiz et al, 2021 ; Zhang et al, 2022 ). However, the exact mechanism underlying DILI in COVID-19 patients were not yet fully understood and no systematic analysis exists.…”

COVID-19 drug-induced liver injury: A recent update of the literature

“…Laboratory findings of liver injury include an increase in aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase, lactate dehydrogenase, hyperbilirubinemia, prolonged prothrombin time. and hypoalbuminemia (Table 1 )[ 8 - 11 ].…”