Impact of COVID-19 on liver

Abstract

The incidence of liver injury after coronavirus disease 2019 (COVID-19) infection ranged from 15%-53%. The mechanism includes direct viral cytopathic effect, cytokinesis, and treatment drug-induced liver injury. The symptoms include nausea, vomiting, diarrhea, and loss of appetite. The laboratory results include increased liver enzyme levels, decreased monocyte count, and longer prothrombin time. The most common imaging findings are hepatomegaly on ultrasound, ground-glass opacity on chest computed tomography (CT), and liver hypodensity and pericholecystic fat stranding on abdominal CT. Patients may also have different presentations and poor outcomes of different liver diseases concomitant with COVID-19 infection. Liver function test (LFT) results should be monitored, and all factors known to cause or predispose liver injury should be investigated while managing the patients. The risks of transfer to an intensive care unit, need for mechanical ventilator support, and acute kidney injury is higher in COVID-19 patients with than without abnormal LFTs. Increased mortality and length of hospital stay are both observed.

Keywords: COVID-19; Fatty liver; Liver cirrhosis; Hepatitis; Hypoalbuminemia; Hepatic injury

Core Tip: The main cause of mortality in coronavirus disease 2019 (COVID-19) infection is a respiratory complication, but the liver is one of the most affected organs after the respiratory system. The incidence of liver injury after COVID-19 infection ranges from 15%-53%. COVID-19-infected patients with liver injury may have higher liver enzyme levels, lower monocyte count and longer prothrombin time than those without liver injury. The risks of transfer to an intensive care unit, need of mechanical ventilator support, and acute kidney injury are higher in COVID-19 patients with, than in those without, abnormal liver function tests. Increased mortality and longer length of hospital stay are both observed.