Liver injury in COVID-19: A minireview

Table 1 Abnormal liver function with existing liver disease and effects of COVID-19

Ref.	No. of patients included	No. of patients with preexisting liver disease	Liver function markers	Impact on disease
Cirrhosis
Iavarone et al[76], 2020	399	50	Bilirubin and ALT significantly increased, while albumin significantly decreased	Elevated transaminases may have an adverse impact on the process of cirrhosis and the 30-d mortality rate was higher in those patients who had impaired liver function
Marjot et al[77], 2021	745	386	-	SARS-CoV-2 infection in patients with cirrhosis appears to be associated with high rates of acute hepatic decompensation (46%) and patients would have a 2-fold increased rate of mortality
Hepatitis B
Zou et al[78], 2021	105	105	Elevated levels of ALT (22, 20.95%), AST (29, 27.62%), total bilirubin (7, 6.67%), GST (7, 6.67%), and ALP (1, 0.95%)	Liver injury in patients with SARS-CoV-2 and chronic HBV co-infection was associated with disease severity
Chen et al[82], 2020	376	20	No significant increase	Coinfection with SARS-CoV-2 and HBV slightly affected liver function and had no effect on COVID-19 outcomes
MAFLD
Zhou et al[88], 2020	327	93	-	Younger COVID-19 patients (aged < 60 years) with MAFLD have a more than 2-fold higher prevalence of severe COVID-19 while MAFLD in older patients appears to have no relation to the severity of the disease
Tripon et al[89], 2022	719	445	-	SARS-CoV-2-induced cytokine storm can be enhanced in patients with a preexisting liver disease like NAFLD
ALD
Kim et al[94], 2021	367	94	-	Patients with ALD were at higher risk of contracting COVID-19 due to their immune system dysregulation and SARS-CoV-2-induced cytokine storm may exacerbate inflammation in ALD patients
Liver transplant
Fraser et al[72], 2020	223	223	-	In liver transplant recipients with COVID-19, 77.7% required hospitalization, 36% experienced more severe disease, and the mortality rate observed in the cohort was 19.3%
Colmenero et al[97], 2021	111	111	-	In liver transplant patients, chronic immune-suppression increases the risk of developing COVID-19 but it could reduce disease severity and the mortality

SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GST: Gamma-glutamyl transpeptidase; MAFLD: Metabolic dysfunction-associated fatty liver disease; ALD: Alcoholic liver disease.