Published online Feb 7, 2021. doi: 10.3748/wjg.v27.i5.377
Peer-review started: October 20, 2020
First decision: December 18, 2020
Revised: December 25, 2020
Accepted: January 8, 2021
Article in press: January 8, 2021
Published online: February 7, 2021
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has undoubtedly revolutionized the whole globe and given a new point of view on respiratory tract infections. Nevertheless, coronavirus disease 2019 (COVID-19) cannot be perceived as a disease limited only to pneumonia with diverse severity. More and more reports have demonstrated a wide range of possible systemic symptoms, including hepatic complications. Liver injury has been observed in a significant proportion of patients, especially in those with a severe or critical illness. COVID-19 might provoke a deterioration of liver function in patients with already diagnosed chronic liver diseases and without pre-existing liver disorders. The deterioration of liver function worsens the prognosis, increases the risk of a severe course of SARS-CoV-2 infection and prolongs the hospital stay. In general, patients who develop liver dysfunction in COVID-19 are mainly males, elderly people, and those with higher body mass index. The underlying mechanisms for hepatic failure in patients infected with SARS-CoV-2 are still unclear, nevertheless liver damage appears to be directly connected with virus-induced cytopathic effects. A liver injury observed during hospitalization might be simultaneously caused by the use of potentially hepatotoxic drugs, mainly antiviral agents. This minireview focuses on a possible relationship between COVID-19 and the liver, potential molecular mechanisms of liver damage, the characteristics of liver injury and suggested factors predisposing to hepatic manifestations in COVID-19 patients.
Core Tip: The coronavirus disease 2019 (COVID-19) pandemic has revolutionized the priorities of the medical society worldwide. In the natural history of severe acute respiratory syndrome coronavirus-2 infection, liver injury is relatively frequent but quite mild and it is described as any liver damage occurring during disease progression and treatment of infection in patients with or without pre-existing liver disorders. Direct viral cytopathic injury, secondary liver impairment due to systemic inflammatory response or hypoxia, drug-induced liver failure and finally the exacerbation of chronic liver diseases are enumerated as potential etiologic factors for liver injury in COVID-19.