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World J Virol. Jan 25, 2023; 12(1): 22-29
Published online Jan 25, 2023. doi: 10.5501/wjv.v12.i1.22
Association between COVID-19 and chronic liver disease: Mechanism, diagnosis, damage, and treatment
Ruo-Bing Qi, Zheng-Hao Wu
Ruo-Bing Qi, Zheng-Hao Wu, Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Ruo-Bing Qi, Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Author contributions: Qi RB and Wu ZH conceived the study and wrote the manuscript.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Hao Wu, MD, Doctor, Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hanghang Road, Qiaokou District, Wuhan 430000, Hubei Province, China. wu_zhenghao@126.com
Received: September 8, 2022
Peer-review started: September 8, 2022
First decision: September 19, 2022
Revised: October 3, 2022
Accepted: November 21, 2022
Article in press: November 21, 2022
Published online: January 25, 2023
Processing time: 131 Days and 12.6 Hours
Abstract

As the outbreak evolves, our understanding of the consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (COVID-19) on the liver has grown. In this review, we discussed the hepatotropic nature of SARS-CoV-2 and described the distribution of receptors for SARS-CoV-2 (e.g., angiotensin-converting enzyme 2) in the vascular endothelium and cholangiocytes of the liver. Also, we proposed mechanisms for possible viral entry that mediate liver injury, such as liver fibrosis. Due to SARS-CoV-2-induced liver damage, many COVID-19 patients develop liver dysfunction, mainly characterized by moderately elevated serum aminotransferase levels. Patients with chronic liver disease (CLD), such as cirrhosis, hepatocellular carcinoma, nonalcoholic fatty liver disease, and viral hepatitis, are also sensitive to SARS-CoV-2 infection. We discussed the longer disease duration and higher mortality following SARS-CoV-2 infection in CLD patients. Correspondingly, relevant risk factors and possible mechanisms were proposed, including cirrhosis-related immune dysfunction and liver deco-mpensation. Finally, we discussed the potential hepatotoxicity of COVID-19-related vaccines and drugs, which influence the treatment of CLD patients with SARS-CoV-2 infection. In addition, we suggested that COVID-19 vaccines in terms of immunogenicity, duration of protection, and long-term safety for CLD patients need to be further researched. The diagnosis and treatment for liver injury caused by COVID-19 were also analyzed in this review.

Keywords: SARS-CoV-2; COVID-19; Chronic liver disease; Angiotensin-converting enzyme 2; Hepatotoxicity; Calcineurin inhibitors

Core Tip: In this review, we discussed the hepatotropic nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and described the distribution of receptors for SARS-CoV-2 in the vascular endothelium and cholangiocytes of the liver. We proposed mechanisms for possible viral entry that mediate liver injury, such as liver fibrosis. Due to SARS-CoV-2-induced liver damage, many coronavirus disease 2019 (COVID-19) patients develop liver dysfunction. We discussed the longer disease duration and higher mortality following SARS-CoV-2 infection in chronic liver disease patients. Correspondingly, relevant risk factors and possible mechanisms were proposed. Finally, we discussed the potential hepatotoxicity of COVID-19-related vaccines and drugs.