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World J Gastroenterol. Sep 21, 2021; 27(35): 5919-5931
Published online Sep 21, 2021. doi: 10.3748/wjg.v27.i35.5919
Liver-spleen axis dysfunction in COVID-19
Sara Cococcia, Marco Vincenzo Lenti, Giovanni Santacroce, Giovanna Achilli, Federica Borrelli de Andreis, Antonio Di Sabatino
Sara Cococcia, Marco Vincenzo Lenti, Giovanni Santacroce, Giovanna Achilli, Federica Borrelli de Andreis, Antonio Di Sabatino, First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
Sara Cococcia, Department of Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom
Author contributions: All authors significantly participated in the drafting of the manuscript or in its critical revision for important intellectual content and the approval of the final submitted version; Cococcia S, Borrelli de Andreis F, Santacroce G, and Achilli G wrote the manuscript; Di Sabatino A and Lenti MV supervised the other authors, reviewed the paper, and carried out the final critical revision for important intellectual content.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
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: Marco Vincenzo Lenti, MD, Academic Research, Research Assistant Professor, First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Viale Golgi 19, Pavia 27100, Italy. marco.lenti@unipv.it
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: April 29, 2021
Revised: May 1, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: September 21, 2021
Abstract

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly through the respiratory route. Besides interstitial pneumonia, a number of other clinical manifestations were noticed in COVID-19 patients. In particular, liver and spleen dysfunctions have been described both as complications of COVID-19 and as potential predisposing factors for severe COVID-19. Liver damage is rather common in COVID-19 patients, and it is most likely multifactorial, caused by the direct insult of SARS-CoV-2 to the liver by the cytokine storm triggered by the virus, by the use of hepatotoxic drugs, and as a consequence of hypoxia. Although generally mild, liver impairment has been found to be associated with a higher rate of intensive care unit admission. A higher mortality rate was reported among chronic liver disease patients. Instead, spleen impairment in patients with COVID-19 has been poorly described. The main anatomical changes are the architectural derangement of the B cell compartment, white pulp atrophy, and reduction or absence of lymphoid follicles, while, from a functional point of view, the IgM memory B cell pool is markedly depleted. The outcome of COVID-19 in asplenic or hyposplenic patients is yet to be defined. In this review, we will summarise the current knowledge regarding the impact of SARS-CoV-2 on the liver and spleen function, as well as the outcome of patients with a pre-existent liver disease or defective spleen function.

Keywords: Asplenia, Chronic liver disease, IgM memory B cell, Liver transplantation, Transaminase

Core Tip: The severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide, primarily causing interstitial pneumonia, although many other organs can be involved. Here, we will discuss the current knowledge regarding the liver and spleen involvement caused by this infection.