Gracia-Ramos AE, Jaquez-Quintana JO, Contreras-Omaña R, Auron M. Liver dysfunction and SARS-CoV-2 infection. World J Gastroenterol 2021; 27(26): 3951-3970 [PMID: 34326607 DOI: 10.3748/wjg.v27.i26.3951]
Corresponding Author of This Article
Abraham Edgar Gracia-Ramos, MD, MSc, Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, C.P., Mexico City 02990, Mexico. dr.gracia.dmm@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Frontier
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 14, 2021; 27(26): 3951-3970 Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.3951
Liver dysfunction and SARS-CoV-2 infection
Abraham Edgar Gracia-Ramos, Joel Omar Jaquez-Quintana, Raúl Contreras-Omaña, Moises Auron
Abraham Edgar Gracia-Ramos, Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
Joel Omar Jaquez-Quintana, Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
Raúl Contreras-Omaña, Centro de Estudio e Investigación en Enfermedades Hepáticas y Toxicológicas (CEIHET), Pachuca 42184, Mexico
Moises Auron, Departments of Hospital Medicine and Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: The authors contributed equally to all aspects of this manuscript preparation and have read and approved the final manuscript; each author meets the criteria for authorship established by the International Committee of Medical Journal Editors.
Conflict-of-interest statement: The authors declare having no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abraham Edgar Gracia-Ramos, MD, MSc, Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, C.P., Mexico City 02990, Mexico. dr.gracia.dmm@gmail.com
Received: March 16, 2021 Peer-review started: March 16, 2021 First decision: May 1, 2021 Revised: May 9, 2021 Accepted: June 16, 2021 Article in press: June 16, 2021 Published online: July 14, 2021
Abstract
Severe acute respiratory syndrome coronavirus 2 infection is the cause of coronavirus disease 2019 (COVID-19), which predominantly affects the respiratory system; it also causes systemic and multi-organic disease. Liver damage is among the main extrapulmonary manifestations. COVID-19-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease, and occurs in approximately one in five patients. Abnormal liver test results have been associated with a more severe course of COVID-19 and other complications, including death. Mechanisms linking COVID-19 to liver injury are diverse. Particular consideration should be made for patients with pre-existing liver disease, such as metabolic dysfunction-associated fatty liver disease, chronic liver disease due to viral or autoimmune disease, liver transplant carriers, or cirrhosis, given the risk for more severe outcomes. This manuscript summarizes the current lines of evidence on COVID-19-associated liver injury regarding pathophysiology, clinical significance, and management in both patients with or without pre-existing liver disease, to facilitate clinicians’ access to updated information and patient care. Finally, we mention the ideas and recommendations to be considered for future research.
Core Tip: Coronavirus disease 2019 (COVID-19)-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease, with an observed ratio of 1:5. The presence of abnormal liver biochemical parameters has been associated with a severe course of severe acute respiratory syndrome coronavirus 2 infection and other complications, including death. Pathophysiology of COVID-19-induced liver injury is complex. Also, special consideration should be made in patients with pre-existing liver disease, such as metabolic dysfunction-associated fatty liver disease, chronic liver disease due to viral or autoimmune disease, liver transplant carriers, or cirrhosis.
