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World J Virol. Sep 25, 2022; 11(5): 237-251
Published online Sep 25, 2022. doi: 10.5501/wjv.v11.i5.237
Association of COVID-19 with hepatic metabolic dysfunction
Ramesh Kumar, Vijay Kumar, Rahul Arya, Utpal Anand, Rajeev Nayan Priyadarshi
Ramesh Kumar, Rahul Arya, Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
Vijay Kumar, Department of Medicine, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
Utpal Anand, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
Rajeev Nayan Priyadarshi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
Author contributions: Kumar R, Kumar V, and Arya R contributed in concept and design of manuscript, data collection and manuscript writing; Anand U and Priyadarshi RN contributed in data collection, critical inputs and manuscript revision.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Associate Professor, Department of Gastro-enterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Received: March 13, 2022
Peer-review started: March 13, 2022
First decision: April 13, 2022
Revised: April 25, 2022
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: September 25, 2022
Abstract

The coronavirus disease 2019 (COVID-19) pandemic continues to be a global problem with over 438 million cases reported so far. Although it mostly affects the respiratory system, the involvement of extrapulmonary organs, including the liver, is not uncommon. Since the beginning of the pandemic, metabolic com-orbidities, such as obesity, diabetes, hypertension, and dyslipidemia, have been identified as poor prognostic indicators. Subsequent metabolic and lipidomic studies have identified several metabolic dysfunctions in patients with COVID-19. The metabolic alterations appear to be linked to the course of the disease and inflammatory reaction in the body. The liver is an important organ with high metabolic activity, and a significant proportion of COVID-19 patients have metabolic comorbidities; thus, this factor could play a key role in orchestrating systemic metabolic changes during infection. Evidence suggests that metabolic dysregulation in COVID-19 has both short- and long-term metabolic implications. Furthermore, COVID-19 has adverse associations with metabolic-associated fatty liver disease. Due to the ensuing effects on the renin-angiotensin-aldosterone system and ammonia metabolism, COVID-19 can have significant implications in patients with advanced chronic liver disease. A thorough understanding of COVID-19-associated metabolic dysfunction could lead to the identification of important plasma biomarkers and novel treatment targets. In this review, we discuss the current understanding of metabolic dysfunction in COVID-19, focusing on the liver and exploring the underlying mechanistic pathogenesis and clinical implications.

Keywords: COVID-19, Coronavirus, Metabolism, Metabolic syndrome, Metabolic inflammation, Hepatic dysfunction

Core Tip: In coronavirus disease 2019 (COVID-19) patients, the virus induces a complex viral-host interaction that leads to metabolic reprogramming, altered immunological responses, and a variety of clinical consequences. In metabolomic and lipidomic studies, a variety of alterations in amino acids, lipids, carbohydrates, and energy metabolism have been identified in such patients. The liver is the primary metabolic organ; thus, these metabolic alterations may have a major impact on patients with liver diseases and metabolic comorbidities that are common in COVID-19 patients. Therefore, this review article discusses the pathophysiological aspects and clinical implications of metabolic dysfunction in COVID-19 patients with a focus on the liver.