COVID-19 and Liver Dysfunction: Current Insights and Emergent Therapeutic Strategies

Abstract

The outbreak of coronavirus disease 2019 , caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has attracted increasing worldwide attention. Cases of liver damage or dysfunction (mainly characterized by moderately elevated serum aspartate aminotransferase levels) have been reported among patients with COVID-19. However, it is currently uncertain whether the COVID-19related liver damage/dysfunction is due mainly to the viral infection per se or other coexisting conditions, such as the use of potentially hepatotoxic drugs and the coexistence of systemic inflammatory response, respiratory distress syndromeinduced hypoxia, and multiple organ dysfunction. Based on the current evidence from case reports and case series, this

Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease

“…This suggests IL-6 is a key proinflammatory factor that triggers the inflammatory "storm" in patients. [13] In MAFLD patients, particularly those with obesity, increased inflammatory activity in the liver and visceral fat is independently correlated with increased levels of IL-6, [14] which might have an additive/synergistic role in promoting greater severity of COVID-19. It is conceivable that the secretion of hepatokines for example, reduced adiponectin or the altered secretion of inflammatory lipid mediators in obese patients with MAFLD, [15] may also contribute to the current observations.…”

Plasma CRP level is positively associated with the severity of COVID-19

“…It binds to a variety number of eukaryotic and prokaryotic pathogens, facilitating complement activation through classical pathway [8], indicating immune activation, lymphocyte infiltration, immune molecules consumption and inflammation outbreak. Clinically, increased CRP levels might be early indicators of nosocomial infections in COVID-19 patients who were slow to recover, and might aid physicians to administer empirical antibiotics treatment early to prevent worsened outcome [9,10].…”

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

“…It remains unclear whether liver injury is caused by the virus itself or reflects a severe inflammatory response with liver damage. 28 SARS-CoV-2 may directly infect liver cells as the receptor of the virus, angiotensin-converting enzyme 2 (ACE2), is expressed by liver and bile duct cells. 29 Data from two independent cohorts revealed ACE2 expression in 2.6% of hepatocytes and 59.7% of cholangiocytes, suggesting that SARS-CoV-2 might directly bind to ACE2-positive cholangiocytes to dysregulate liver function.…”