Minireviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2023; 11(3): 514-527
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.514
Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19
Asimina Valsamaki, Maria Xanthoudaki, Katerina G Oikonomou, Panagiotis J Vlachostergios, Antonios Papadogoulas, Periklis Katsiafylloudis, Ioanna Voulgaridi, Apostolia-Lemonia Skoura, Apostolos Komnos, Panagiotis Papamichalis
Asimina Valsamaki, Maria Xanthoudaki, Katerina G Oikonomou, Antonios Papadogoulas, Periklis Katsiafylloudis, Apostolos Komnos, Panagiotis Papamichalis, Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
Panagiotis J Vlachostergios, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States
Ioanna Voulgaridi, Department of Microbiology, General Hospital of Larissa, Larissa 41221, Greece
Apostolia-Lemonia Skoura, Transfusion Medicine Department, University Hospital of Larissa, Larissa 41110, Greece
Author contributions: Papamichalis P and Oikonomou KG designed the review; Papadogoulas A, Katsiafylloudis P, Voulgaridi I and Skoura AL gathered the data; Papamichalis P, Oikonomou KG, Valsamaki A and Xanthoudaki M analyzed, interpreted the data and wrote the final version of the manuscript; Oikonomou KG and Vlachostergios PJ performed English editing; Komnos A critically reviewed the paper; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
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: Panagiotis Papamichalis, MD, PhD, Consultant Physician-Scientist, Doctor, Intensive Care Unit, General Hospital of Larissa, Tsakalof 1, Larissa 41221, Greece. ppapamih@med.uth.gr
Received: October 12, 2022
Peer-review started: October 12, 2022
First decision: November 26, 2022
Revised: December 5, 2022
Accepted: January 10, 2023
Article in press: January 10, 2023
Published online: January 26, 2023
Processing time: 105 Days and 22.5 Hours
Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.

Keywords: Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus 2; Liver disease; Intensive care unit; Liver unit; Prealbumin

Core Tip: The liver follows the respiratory system with a lower but considerable frequency of affection by severe acute respiratory syndrome coronavirus 2. Coronavirus disease 2019 causes acute and acute-on-chronic liver injury. The pathophysiological mechanisms are complex. Certain biomarkers such as fibrosis-4 score and non-invasive point-of-care methods such as ultrasonography or transient elastography can be extremely helpful in the early diagnosis of liver injury and the assessment of its progression. Health systems, intensive care units, liver units and transplant programs were seriously affected by the pandemic. The clinician should recognize the symptoms and signs of liver injury early and take the appropriate measures to reverse it.