COVID-19 and liver injury: An ongoing challenge

Abstract

The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in December 2019, in Wuhan, China. The virus was rapidly spread worldwide, causing coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is presented, usually, with typical respiratory symptoms ( i.e. , dyspnea, cough) and fever, extrapulmonary manifestations are also encountered. Liver injury is a common feature in patients with COVID-19 and ranges from mild and temporary elevation of liver enzymes to severe liver injury and, even, acute liver failure. The pathogenesis of liver damage is not clearly defined; multiple mechanisms contribute to liver disorder, including direct cytopathic viral effect, cytokine storm and immune-mediated hepatitis, hypoxic injury, and drug-induced liver toxicity. Patients with underlying chronic liver disease ( i.e. , cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc .) may have greater risk to develop both severe COVID-19 and further liver deterioration, and, as a consequence, certain issues should be considered during disease management. The aim of this review is to present the prevalence, clinical manifestation and pathophysiological mechanisms of liver injury in patients with SARS-CoV-2 infection. Moreover, we overview the association between chronic liver disease and SARS-CoV-2 infection and we briefly discuss the management of liver injury during COVID-19.

Drug‐induced liver injury as assessed by the updated Roussel Uclaf Causality Assessment Method following mild COVID‐19 in a patient under anastrozole therapy—A case report

“…Liver injury is a common feature in COVID-19 patients and is associated with disease severity and prognosis usually exhibiting mild elevation of the aminotransferases <5 times above the upper limit of normal (ULN), only. 10 In such cases, liver injury was transient with liver function parameters returning to normal within 2-3 weeks. 11 In contrast, increased GGT and/or ALP are less common features, mainly observed in later disease stages.…”

“…11 In contrast, increased GGT and/or ALP are less common features, mainly observed in later disease stages. 10 Severe hepatotoxicity (i.e., aminotransferases elevation >20 times ULN) has been reported to affect 2% of hospitalized COVID-19 patients, with acute liver failure being an extremely rare event. 17 A recent study including 158 hospitalized patients showed, that the incidence of abnormal liver function tests (LFTs) was significantly higher in severe than in nonsevere COVID-19 cases.…”

“…No changes in our patient's habits or diet have occurred and no new dietary supplements or herbal drugs have been introduced. Liver injury is a common feature in COVID‐19 patients and is associated with disease severity and prognosis usually exhibiting mild elevation of the aminotransferases <5 times above the upper limit of normal (ULN), only 10 . In such cases, liver injury was transient with liver function parameters returning to normal within 2–3 weeks 11 .…”

“…In such cases, liver injury was transient with liver function parameters returning to normal within 2–3 weeks 11 . In contrast, increased GGT and/or ALP are less common features, mainly observed in later disease stages 10 . Severe hepatotoxicity (i.e., aminotransferases elevation >20 times ULN) has been reported to affect 2% of hospitalized COVID‐19 patients, with acute liver failure being an extremely rare event 17 .…”

“…A significant proportion (i.e., 16%–55%) of Coronavirus Disease 2019 (COVID‐19) patients presenting with elevated liver enzymes have been reported worldwide, 7–9 with most cases not showing specific signs and symptoms 10 . In this respect, alanine aminotransaminase (ALT), and aspartate aminotransaminase (AST) elevation is very common in COVID‐19 patients, while increased gamma‐glutamyl transpeptidase (GGT) and/or alkaline phosphatase (ALP) is a less usual finding, mainly observed in later disease stages 11,12 …”