Review
Copyright ©The Author(s) 2023.
World J Gastroenterol. Jan 21, 2023; 29(3): 425-449
Published online Jan 21, 2023. doi: 10.3748/wjg.v29.i3.425
Table 1 Explore the main causes of liver injuries during COVID-19
Cause of liver injury
The main finding of the study
Ref.
SARS-CoV-2 directly invades the liver and displays hepatic impairment characterized by liver enzyme abnormalitiesWang et al[84], 2020
SARS-CoV-2 tropismIntrahepatic SARS-CoV-2 contributes to liver inflammation, endothelium, and bile duct damageFiel et al[97], 2021
SARS-CoV-2 cytopathic effect involved in the rapid progression of acute liver injury to acute liver failureMelquist et al[98], 2020
Cytokine stormElevation of liver enzymes in COVID-19 is mainly related to immune dysregulation caused by cytokine storm and hepatic damageLi et al[106], 2020
Systemic inflammation is the fuel for hepatic injury in COVID-19 patientsEffenberger et al[244], 2021
Hypoxic liver injuryHypoxic hepatitis is not a rare condition in COVID-19 patients admitted to the intensive care unit and is dramatically associated with elevated liver enzymesHuang et al[117], 2020
Hepatic artery thrombosis is highly associated with hepatic injury and abdominal pain during COVID-19Antunes de Brito et al[124],2021
SARS-CoV-2 induces severe disruption of the intrahepatic blood vessel and also affects the endothelial layer of blood vesselsSonzogni et al[125], 2020
Endothelial cells and liver injuryHepatic injury is attributed to platelet-fibrin microthrombi in the hepatic sinusoids along with some portal vein platelet aggregatesRapkiewicz et al[126], 2020
SARS-CoV-2 activates IL-6/JAK/STAT pathway consequently, stimulating coagulopathy and hepatic epitheliopathyMcConnell et al[139], 2021
Table 2 Summarizing the effect of comorbid hepatic disorders with SARS-CoV-2 infection
Hepatic disorders
Main finding
Ref.
SARS-CoV-2 comorbidity with HCV shows a high percentage of ferritin, white blood cell count, prothrombin time, lymphocyte count, and hypoglycemiaCerbu et al[159], 2022
SARS-CoV-2 and HCV coinfection reported higher levels of IL-6 and IL-17, and TNF-α when compared with HCV and COVID-19 aloneLeón et al[161], 2022
HCVThe Serum levels of ALT, AST, CRP and ferritin, and calprotectin were significantly elevated in patients with COVID-19 infection than in patients with active HCV and patients with cured HCV infectionToma et al[160], 2022
HCV patients with SARS-CoV-2 infection are more likely to be hospitalized with a high possibility of liver fibrosis and mortalityButt et al[158], 2021
Individuals with HCV and SARS-CoV-2 co-infection are more vulnerable to developing liver cirrhosisAfifyet al[245], 2021
Patients with a history of HBV are anticipated to have a worse outcome with a high probability of ICU admission, and more organ failuresChoe et al[162], 2022
S SARS-CoV-2 and chronic HBV showed severe monocytopenia, lymphopenia, thrombocytopenia, hypoalbuminemia, and lipid metabolism deficiency in the liverZou et al[164], 2021
HBVPatients with HBV and SARS-CoV-2 coinfection died from severe liver disease and haptic sclerosisChen et al[163], 2020
Patients with HBV who have COVID-19 were more likely to develop devastating illnesses and/or death. Additionally, the elevation of LDH, and D-dimer, with decreased albumin, and albumin/globulin ratio is helpful for early clinical surveillanceWang et al[165], 2022
Patients with DM with advanced liver fibrosis infected by SARS-CoV-2 are assumed to have a 10-time risk of mortality when compared with patients without comorbiditiesKim et al[203], 2021
The high proportion of ICU admission, and the need for mechanical ventilationHassnine et al[206], 2022
Liver cirrhosisPatients with liver cirrhosis and COVID-19 were admitted to the hospital than liver cirrhosis aloneAn et al[208], 2021
Those with cirrhosis alone or cirrhosis with COVID-19 had equal death rates, while patients with COVID-19 alone had a greater mortality rateBajaj et al[209], 2021
HCC predicts a greater mortality rate in individuals with HCC infected by SARS-CoV-2 than COVID-19 alone, especially in patients with obesity, diabetes mellitus, hypertension, and hyperlipidemia, older patients ≥65 years, and Hispanic ethnicityKim et al[211], 2021
HCCHCC and COVID-19 were shown to be more susceptible to have a higher risk of death and admitted to the ICULiang et al[212], 2020
Patients with HCC-COVID-19 coinfection found that about one-third of patients need hospital admission, and two-thirds of patients have an elevation of transaminases. Alkaline phosphatase which independently linked to a high mortality rate, higher C reactive protein levels, and more severe respiratory failure upon admission to the hospitalLeo et al[213], 2022
LT patients with COVID-19 had a considerably increased risk of hospitalization but not a significantly higher risk of mortality, thrombosis, or need for ICU admissionMansoor et al[216], 2021
High alkaline phosphatase levels, and lymphovascular invasionShafiq et al[217], 2022
LTLT cases could be successful in active SARS-CoV-2 patients without developing post-operative COVID-19 symptomsMouch et al[214], 2022
Found that liver transplantation from COVID-19-positive donors to informed recipients who have SARS-CoV-2 immunity may help to increase the donor pool safelyRomagnoli et al[219], 2021
Successful LT In patients with severe liver failure due to cholestasis with a good graft function and recovering function in the native liver remnantRela et al[220], 2022