Published online Jun 14, 2021. doi: 10.3748/wjg.v27.i22.3064
Peer-review started: February 6, 2021
First decision: March 14, 2021
Revised: March 27, 2021
Accepted: May 7, 2021
Article in press: May 7, 2021
Published online: June 14, 2021
The rapid global spread of coronavirus disease 2019 (COVID-19) infection has become a major health issue with higher morbidity and mortality rates. Besides respiratory symptoms, a growing body of evidence indicates a variety of gastrointestinal manifestations including liver involvement. In this regard, several data supported an association between COVID-19 infection and liver injury in adults, while in children there is compelling but currently limited evidence. In particular, patients with COVID-19 have shown a higher risk of liver injury (mainly expressed as increased transaminase levels or hepatic steatosis). Conversely, a greater risk of more severe forms of COVID-19 infection has been observed in subjects with pre-existing chronic liver diseases. The dramatic interplay between COVID-19 and liver damage has been related to the inflammatory pathways chronically active in patients with nonalcoholic fatty liver disease and acutely in those affected by COVID-19, but other different pathogenic mechanisms have also been supposed. Of note, patients with previous metabolic comorbidities also had a higher risk of severe COVID-19 infection. This emphasizes the pathogenic interrelation of the inflammatory pathways with a dysregulated metabolic milieu in COVID-19 patients. Taking into account the prognostic role of fatty liver in COVID-19 patients and its intrinsic relationship with metabolic abnormalities even in childhood, a strict monitoring of this condition is recommended. We aimed to summarize the most recent evidence regarding the potential interplay between pediatric fatty liver and COVID-19.
Core Tip: Both adult and pediatric data recently reported a liver involvement in coronavirus disease 2019 (COVID-19). Although several pathogenic mechanisms have been proposed, inflammatory pathways seem to play a pivotal role in the pathophysiology of liver damage in this viral infection. In particular, a complex and bidirectional relationship has been highlighted between fatty liver and COVID-19. Several data suggested this intriguing interplay by underscoring the need for an early close monitoring of this liver condition with an intrinsic greater cardiometabolic burden.