Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments

Table 2 Treatments of liver injury in coronavirus disease 2019

Mechanisms of liver damage	Treatments	Caution	Ref.
Hepatocellular injury	Hepatoprotective, anti-inflammatory, and jaundice-reducing agents	Preventive administration is not recommended	[109,111,112]
Cytokine storm syndrome	Continuous renal replacement therapy. IL-1 inhibitor, IL-6 inhibitor, TNF inhibitor	IL-1 or IL-6 inhibitors could reduce inflammation; however, they have a potential to cause DILI and worsen clinical conditions	[109,139,140]
DILI	Prompt discontinuation or reduction of doses of suspected triggers. Medication reconciliation is important. Discontinue all non-vital therapy, redundant types/doses, modify course duration	Requires a trade-off between therapeutic effects and side effects	[109]
Reactivation of pre-existing liver disease	Continue treatment for hepatitis B and hepatitis C if already on treatment	Difficulty distinguishing between new-onset liver injury and reactivation of pre-existing liver disease	[16,109]
Hypoxic hepatitis	Circulation and respiratory support	Higher PEEP, which may be needed to improve oxygenation, may affect cardiac output, decreasing hepatic arterial flow, thus enhancing arterial dysfunction	[139,140]

DILI: Drug-induced liver injury; IL: Interleukin; PEEP: Positive end-expiratory pressure; TNF: Tumor necrosis factor alpha.