COVID-19 and liver diseases, what we know so far

Abstract

Coronavirus disease 2019 (COVID-19) pneumonia outbreak started in December 2019. On March 12, 2020, the World Health Organization (WHO) declared that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a pandemic, and as of May 2021, SARS-CoV-2 has infected over 167.3 million patients, including 3.4 million deaths, reported to WHO. In this review, we will focus on the relationship between SARS-CoV-2 infection and the liver. We will discuss how chronic liver diseases affect the COVID-19 disease course and outcomes. We will also discuss the SARS-CoV-2 effects on the liver, mechanisms of acute liver injury, and potential management plans.

Keywords: COIVD-19; SARS-CoV-2; Liver diseases; Transaminases; Non alcoholic fatty liver; Hepatocellular carcinoma

Core Tip: On March 12, 2020, the World Health Organization declared that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was a pandemic. SARS-CoV-2 is notorious for causing gastrointestinal and liver injuries. Liver injury mechanisms include SARS-CoV-2-induced hepatic steatosis, reactivation of pre-existing liver disease, mitochondrial dysfunction, cardiomyopathy with hepatic congestion, immune-mediated damage, hypoxic hepatitis, direct cytotoxicity, drug-induced liver injury, ischemic hepatitis, microthrombotic disease, and extrahepatic release of transaminases. The coronavirus disease 2019 (COVID-19) pandemic has various effects on pre-existing liver conditions that range from care disruptions, exacerbation of liver condition, and higher mortality rates. It is necessary to know the mechanisms of liver injury in COVID-19 disease, epidemiology, clinical presentations, diagnosis, and effects on pre-existing liver conditions.