Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has been a serious threat to global health for nearly 3 years. In addition to pulmonary complications, liver injury is not uncommon in patients with novel COVID-19. Although the prevalence of liver injury varies widely among COVID-19 patients, its incidence is significantly increased in severe cases. Hence, there is an urgent need to understand liver injury caused by COVID-19. Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes. Liver function tests, computed tomography scans, and ultrasound can help evaluate liver injury. Risk factors for liver injury in patients with COVID-19 include male sex, preexisting liver disease including liver transplantation and chronic liver disease, diabetes, obesity, and hypertension. To date, the mechanism of COVID-19-related liver injury is not fully understood. Its pathophysiological basis can generally be explained by systemic inflammatory response, hypoxic damage, ischemia-reperfusion injury, and drug side effects. In this review, we systematically summarize the existing literature on liver injury caused by COVID-19, including clinical features, underlying mechanisms, and potential risk factors. Finally, we discuss clinical management and provide recommendations for the care of patients with liver injury.

Keywords: Liver injury; COVID-19; Clinical feature; Risk factor; Treatment and management strategy

Core Tip: A growing body of evidence suggests that patients with coronavirus disease 2019 (COVID-19) may experience varying degrees of liver injury. The characteristics and mechanisms of liver injury associated with COVID-19 are not fully understood. In this review, we summarized the clinical features, mechanisms, and management strategies of liver injury associated with COVID-19. Moreover, we collected all the information about high risk factors for liver injury from COVID-19, which is of significance and help for further study of liver damage related to severe acute respiratory syndrome coronavirus 2.