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World J Gastroenterol. Feb 7, 2023; 29(5): 815-824
Published online Feb 7, 2023. doi: 10.3748/wjg.v29.i5.815
Outcomes of COVID-19 among patients with liver disease
Isidora Vujčić
Isidora Vujčić, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Belgrade, Serbia
Author contributions: Isidora Vujcic wrote the manuscript and performed the literature search.
Conflict-of-interest statement: The author states there is no conflict of interest to disclose.
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: Isidora Vujčić, MD, PhD, Associate Professor, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26a, Belgrade 11000, Belgrade, Serbia.
Received: September 17, 2022
Peer-review started: September 17, 2022
First decision: November 15, 2022
Revised: December 25, 2022
Accepted: January 20, 2023
Article in press: January 20, 2023
Published online: February 7, 2023

Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease with multi-organ involvement, including impaired liver function. It has been noticed that a significant proportion of COVID-19 patients have liver dysfunction, especially those with a more severe disease course. The coronavirus causes direct damage to the liver using the angiotensin-converting enzyme 2, a cell-surface receptor for cellular entry, that is expressed in the liver. According to previous research, liver enzyme abnormalities were observed in a considerable proportion of COVID-19 patients, and elevated liver transaminases were found in about 20% of these patients, alkaline phosphatase in 6.1%, and gamma-glutamyl transferase in 21.1%. COVID-19 might trigger a deterioration of liver function in patients with pre-existing chronic liver diseases (CLDs) and also in those without previous liver disorders. The majority of COVID-19 patients who develop liver injury are men, the elderly, and those with a higher body mass index. Compared to the general population, COVID-19 is associated with significant morbidity and mortality in patients with liver disease (cirrhosis and liver transplantation recipients). However, some studies indicate that CLDs have a lesser role in determining patient progression towards higher disease severity.

Keywords: Liver disease, COVID-19, Mortality, Prognosis, Liver function

Core Tip: Drastic lifestyle changes during the coronavirus disease 2019 (COVID-19) pandemic have led to an increase in the incidence of liver disease. Liver damage in COVID-19 infection occurs during disease progression in patients with or without previous liver disorders and represents a risk factor for developing severe illness and death. The prognosis of COVID-19 infection depends predominantly on the patients’ characteristics, present comorbidities, severity of clinical symptoms, laboratory parameters, and imaging features. It is important to examine prognostic factors in COVID-19 disease patients with liver disease because it may improve the outcome.