Liver Injury in COVID-19 Patients

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preferentially infects cells in the respiratory tract, but several studies have also demonstrated low levels of SARS-CoV-2 copies in the liver. The hypothesis that patients with COVID-19 may develop liver dysfunction is supported by findings showing abnormal liver test results in such patients, but the exact mechanisms by which SARS-CoV-2 induces liver damage remain unclear. Liver injury in COVID-19 patients has probably a multifactorial etiology including the rapid onset of a systemic pro-inflammatory state due to viral infection, the use of potentially hepatotoxic drugs, pneumonia-associated hypoxia, and the eventual direct injury of the liver by SARS-CoV-2. This chapter will discuss the potential pathophysiological mechanisms for SARS-CoV-2 hepatic tropism and an overview about the main biochemical and histopathological findings observed in liver from COVID-19 patients. Finally, the effects that this infection can produce in patients with chronic liver disease will be also discussed.