SARS-CoV-2 Infection and Liver Disease: A Review of Pathogenesis and Outcomes

Baldelli, Luke; Marjot, Thomas; Barnes, Eleanor; Barritt, A. Sidney; Webb, Gwilym; Moon, Andrew M.

doi:10.5009/gnl220327

Cited by 12 publications

(14 citation statements)

References 104 publications

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“…For adults, four mechanisms have been suggested: direct infection, toxicity from cytokine storm or hypoxic injury associated with severe COVID-19, toxicity from the drugs used to treat COVID-19, and immune phenomena. [14] Direct infection of hepatocytes is unlikely because viral receptors are sparse on hepatocytes, although they do occur in abundance on cholangiocytes. However, there are case reports of acute hepatitis associated with COVID-19, some of them accompanying MIS-C, and others, without significant respiratory involvement.…”

Section: Discussionmentioning

confidence: 99%

Liver abnormalities following SARS-CoV-2 infection in children under 10 years of age

Terebuh,

Olaker,

Kendall

et al. 2023

Preprint

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Objective: Beginning in October 2021 in the US and elsewhere, cases of severe pediatric hepatitis of unknown etiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading etiologic suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities. Design: We conducted a study utilizing retrospective cohorts of de-identified, aggregated data from the electronic health records of over 100 million patients contributed by US health care organizations. Results: Compared to propensity-score-matched children with other respiratory infections, children aged 1-10 years with COVID-19 had a higher risk of elevated transaminases (Hazard ratio (HR) (95% Confidence interval (CI)) 2.16 (1.74-2.69)) or total bilirubin (HR (CI) 3.02 (1.91-4.78)), or new diagnoses of liver diseases (HR (CI) 1.67 (1.21-2.30)) from one to six months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1-4 years), or illness requiring hospitalization all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections. Conclusion: These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1,000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver.

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Section: Discussionmentioning

confidence: 99%

Liver abnormalities following SARS-CoV-2 infection in children under 10 years of age

Terebuh,

Olaker,

Kendall

et al. 2023

Preprint

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show abstract

“…This suggests a false-positive reaction to anti-HEV IgM after the COVID-19 vaccination. COVID-19 infection causes liver injuries such as cholangiopathy and chronic cholestasis, 12 , 13 and COVID-19 vaccination may induce autoimmune hepatitis. However, COVID-vaccination-induced false-positive HEV serology reaction was not yet reported.…”

Section: Discussionmentioning

confidence: 99%

A Silent Outbreak of Hepatitis E Virus (HEV) Infection or False-Positive Reaction of Anti-HEV IgM after COVID-19 Vaccination? Epidemiological Investigation of an Outbreak in a Korean Factory Complex in 2022

Oh,

Choi,

Chang

et al. 2023

Gut and Liver

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Background/Aims To investigate a reported outbreak of presumed hepatitis E virus (HEV) infection in a Korean food manufacturing facility and to explore the association between anti-HEV immunoglobulin M (IgM) positivity and coronavirus disease 2019 (COVID-19) infection or vaccination. Methods Twenty-four cases of anti-HEV IgM positivity were reported among 646 workers at the facility in 2022. An epidemiological investigation was conducted, comprising HEV-RNA testing of blood and environmental samples, analysis of group meal records, and an association between anti-HEV IgM positivity and confirmed COVID-19 infection or vaccination. Results All 24 patients were asymptomatic, with cases spread sporadically across the facility. HEV RNA was not detected in the serum or environmental samples. Four out of 340 meals (1.2%) showed a significantly higher proportion of anti-HEV positivity in each meal intake group than in the non-intake group on certain days. Although the cumulative rate of COVID-19 infection showed no difference, the anti-HEV IgM positive group showed significantly higher proportions of >2 doses of COVID-19 vaccination (83.3% vs 48.7%, p=0.021), vaccination within 90 days (45.8% vs 19.7%, p=0.008), and having the Moderna vaccine administered as the last vaccine (75.0% vs 14.5%, p<0.001) than those of the anti-HEV negative group. In four multivariable models, three or more COVID-19 vaccinations and the Moderna vaccine as the last vaccine were consistently associated with anti-HEV IgM positivity, while the specific day group meal intake was also a significant factor. Conclusions This epidemiological investigation showed that anti-HEV IgM positivity may occur as a false-positive result related to COVID-vaccination over three times and use of the Moderna vaccine, although a portion of true HEV infection may not be excluded.

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“…5,6 Public health measures intended to control the spread of the global pandemic often led to significant increases in alcohol consumption, adoption of a carbohydrate-rich diet and reduced levels of physical activity, further affecting the liver. 4,[7][8][9][10] COVID vaccination has been associated with the development of an autoimmune hepatitis, [11][12][13] while the longer-term effects of infection include the development of secondary sclerosing cholangitis. [14][15][16] Difficulties arise, however, in appraising the current literature, particularly epidemiological and clinical studies, because of the evolving therapeutic landscape over the past 3 years.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and the Liver: A Complex and Evolving Picture

Taylor-Robinson,

Morgan

2023

HMER

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Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, other organs, such as the liver, are also affected. In this overview, the effects of SARS-CoV-2 infection on the liver in both healthy people and in those with pre-existing liver disease are documented; the relationship between coronavirus disease 19 (COVID-19) vaccination and liver injury is examined; the mechanism of SARS-CoV-2-associated liver injury is explored; and the long-term consequences of COVID-19 are delineated, both in people with and without pre-existing liver disease.

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SARS-CoV-2 Infection and Liver Disease: A Review of Pathogenesis and Outcomes

Cited by 12 publications

References 104 publications

Liver abnormalities following SARS-CoV-2 infection in children under 10 years of age

Liver abnormalities following SARS-CoV-2 infection in children under 10 years of age

A Silent Outbreak of Hepatitis E Virus (HEV) Infection or False-Positive Reaction of Anti-HEV IgM after COVID-19 Vaccination? Epidemiological Investigation of an Outbreak in a Korean Factory Complex in 2022

COVID-19 and the Liver: A Complex and Evolving Picture

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