ABSTRACT
Liver enzyme abnormalities occur frequently in patients diagnosed with Coronavirus disease 2019 (COVID-19). It has been suggested that patients with severe acute liver injury are more likely to be admitted to intensive care, require intubation or renal replacement therapy and their mortality rate is higher than patients without severe acute liver injury. This review article explores the possible aetiologies of liver dysfunction seen in patients with COVID-19 and also the effect of COVID-19 on patients with pre-existing liver disease. Finally, we suggest clinical approaches to treating a patient with liver enzyme disturbance and COVID-19 and also caring for patients who require liver transplantation in the COVID-19 era.Copyright © 2022 Bentham Science Publishers.
ABSTRACT
The coronavirus SARS-CoV-2 (Covid-19) has resulted in a worldwide pandemic. Covid-19 binds to the angiotensin-converting enzyme 2 (ACE-2) receptor and is endocytosed. The ACE-2 receptor is found in many organs including the lung and liver. Liver enzyme abnormalities are found in many patients with Covid-19, the majority of which are not severe. The abnormities are mainly hepatocellular. Aspartat aminotransferase (AST) blood level is higher than alanine aminotransferase (ALT). Covid-19 enters the portal circulation via the brush border on enterocytes and hepatic Kupffer cells mount an inflammatory response. The causes of liver injury include an inflammatory response in the liver, hypoxic hepatitis due to cardiovascular congestion, the Covid-19 related cytokine storm, co-medication including remdesivir and toclizumab and a hypercoagulable state. Patients with Covid-19 may have preexisting liver diseases and in these cases a higher percentage of patients have elevated liver enzymes on admission. These diseases include metabolic associated fatty liver disease (MAFLD) (which shares Covid-19 poor prognostic factors), chronic hepatitis B virus (HBV) and hepatitis C virus infection (HCV), autoimmune hepatitis, alcoholic liver disease cirrhosis and its complications including hepatocellular carcinoma and liver transplant recipients. We review the literature and suggest a therapeutic approach.