Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.

Liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions

“…The literature reports several case series on patients with coronavirus disease-19 on ECMO, where encouraging results were obtained following the use of Cytosorb. In contrast, other trials have not reported any benefits in terms of mortality, vasopressor requirement, and organ dysfunction[ 1 , 19 ].…”

“…Artificial extracorporeal blood purification techniques offer the possibility of liver replacement therapy (LRT) in patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). Artificial liver support systems (LSSs) can efficiently remove cytokines and a wide variety of hepatotoxic metabolites, including ammonia, fatty acids, bilirubin, bile acids, and amino acids[ 1 ]. The removal of cytokines using LSSs has been shown to intervene in the immunologic processes occurring during ALF and ACLF.…”