Review article: COVID‐19 and liver disease—what we know on 1st May 2020

Abstract

SummaryBackgroundSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the causative pathogen of coronavirus disease 2019 (COVID‐19), became a global threat to human health. Liver impairment has been frequently reported as a common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver disease (CLD).AimsTo summarise the changes in liver function tests during SARS‐CoV‐2 infection and the impact of COVID‐19 in patients with underlying CLD.MethodsA literature review using online database PubMed was done using the search terms “SARS‐CoV‐2”, “COVID‐19”, “liver”, “cirrhosis” and “liver transplantation”.ResultsCOVID‐19 is frequently associated with different degrees of abnormal liver function tests, most notably transaminases, which are usually transitory and of mild degree. Available evidence suggests that liver injury may result from direct pathogenic effect by the virus, systemic inflammation or toxicity from commonly used drugs in this subset of patients. SARS‐CoV‐2 infection in children is associated with minimal or no increase in liver enzymes, thus the presence of abnormal liver function tests should trigger evaluation for underlying liver diseases. Although it seems that patients with CLD are not at greater risk for acquiring the infection, those with cirrhosis, hepatocellular carcinoma, non‐alcoholic fatty liver disease, autoimmune liver diseases or liver transplant may have a greater risk for severe COVID‐19.ConclusionsAbnormal liver function tests during the course of COVID‐19 are common, though clinically significant liver injury is rare. Further research is needed focusing on the effect of existing liver‐related comorbidities on treatment and outcome of COVID‐19.

Letter: liver disease and COVID‐19—not the perfect storm

“…Immune dysfunction has been well described in cirrhotic patients resulting in a high risk of infection and cirrhotic patients have poor outcomes with acute respiratory distress syndrome (ARDS). 4 In our cohort, 89/535 (16.6%) had suspected pre-existing liver disease based on radiological and laboratory results, including 21/535 (3.9%) with cirrhosis, supporting previously reported rates, 1 and 13/21 (61.9%) had decompensated cirrhosis (Child-Pugh B/C) ( Table 1). The main aetiology of cirrhosis was alcohol (47.6%).…”

“…We read with great interest the article by Garrido et al on COVID-19 and liver disease. 1 We agree that COVID-19 is associated with elevated liver enzymes, but its significance needs to be further elucidated as well as the impact of underlying liver disease on COVID-19. From 535 patients SARS-CoV-2 patients admitted at Imperial College Healthcare NHS Trust, London, from 25 February to 5 of April 2020, 2 we found 27.7% (148/535) had elevated liver transaminases.…”

“…liver cirrhosis does not predispose to increase mortality but does increase length of stay. Benjamin H. Mullish 1,2 Nikhil Vergis 1,2 Nowlan Selvapatt 1,2 Pinelopi Manousou 1,2 Shevanthi Nayagam 1,2 Maud Lemoine 1,2 Ameet Dhar In conclusion, it is essential to make immediate contact after the appearance of signs or symptoms compatible with or decompensated cirrhosis for urgent referral and management.…”

Letter: unknown denominator and misleading conclusions in COVID‐19

“…Complete withdrawal of mycophenolate mofetil upon admission might be useful although further studies are needed. Manuel Rodríguez-Perálvarez 1,2 Magdalena Salcedo 2,3 José Antonio Pons 4 Jordi Colmenero 2,5 the Spanish Society of Liver Transplantation (SETH)…”

Letter: unknown denominator and misleading conclusions in Covid‐19—authors' reply

“…9ACK N OWLED G EM ENTSThe authors' declarations of personal and financial interests are unchanged from those in the original article 2 .LI N K ED CO NTENTThis article is linked to Garrido et al and Rodríguez-Perálvarez et al papers. To view these articles, visit https://doi.org/10.1111/apt.15813 and https://doi.org/10.1111/apt.16038 Isabel Garrido1,2…”