Published online Feb 14, 2023. doi: 10.3748/wjg.v29.i6.908
Peer-review started: September 12, 2022
First decision: December 12, 2022
Revised: December 18, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 14, 2023
Coronavirus disease 2019 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 that manifests as a variety of clinical manifestations, including liver damage commonly detected by a hepatocellular pattern from liver function tests. Liver injury is associated with a worse prognosis overall. Conditions associated with the severity of the disease include obesity and cardiometabolic comorbidities, which are also associated with nonalcoholic fatty liver disease (NAFLD). The presence of NAFLD, similarly to obesity, is associated with an unfavourable impact on the coronavirus disease 2019 outcome. Individuals with these conditions could present with liver damage and elevated liver function tests due to direct viral cytotoxicity, systemic inflammation, ischemic or hypoxic liver damage or drug side effects. However, liver damage in the setting of NAFLD could also be attributed to a pre-existing chronic low-grade inflammation associated with surplus and dysfunctional adipose tissue in these individuals. Here we investigate the hypothesis that a pre-existing inflammatory status is exacerbated after severe acute respiratory syndrome coronavirus 2 infection, which embodies a second hit to the underestimated liver damage.
Core Tip: The severe acute respiratory syndrome coronavirus 2 that causes coronavirus disease 2019 has a variety of clinical manifestations, including liver damage. Obesity and other dysmetabolic diseases linked to nonalcoholic fatty liver disease are a few of the factors that contribute to the severity of the illness. Due to direct viral cytotoxicity, people with these illnesses may have liver damage and increased liver function tests. However, liver injury might also be related to pre-existing inflammation and the detrimental effects of excessive and dysfunctional adipose tissue in these people.