Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2021; 27(5): 377-390
Published online Feb 7, 2021. doi: 10.3748/wjg.v27.i5.377
Liver injury in the era of COVID-19
Halina Cichoż-Lach, Agata Michalak
Halina Cichoż-Lach, Agata Michalak, Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Jaczewskiego 8, Lublin 20-954, Poland
Author contributions: Cichoż-Lach H designed and coordinated the study; Michalak A acquired and analyzed the data; Cichoż-Lach H and Michalak A wrote the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: Authors declare 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:
Corresponding author: Halina Cichoż-Lach, PhD, Full Professor, Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Jaczewskiego 8, Lublin 20-954, Poland.
Received: October 20, 2020
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.

Keywords: SARS-CoV-2 infection, COVID-19, Acute liver failure, Chronic liver diseases, Inflammation

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.