COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations

Table 1 The association of different underlying liver diseases with clinical outcomes of coronavirus disease 2019

Underlying liver disease/condition	Findings
Autoimmune hepatitis	AIH vs other CLDs: No significant differences in hospital admission (76% vs 85%; P = 0.06), ICU admission (29% vs 23%; P = 0.240), and mortality (23% vs 20%; P = 0.643) rates; AIH vs non-CLDs: Higher hospitalization rate, but similar rate for other outcomes; Severity of AIH associates with COVID-19 mortality, as follows: Age OR per 10 years: 2.01 (95%CI: 1.07-3.81); Child-Pugh B cirrhosis OR: 42.48 (95%CI: 4.41-409.53); Child-Pugh C cirrhosis OR: 69.30 (95%CI: 2.83-1694.50)[93]
Viral hepatitis	The risk of severe COVID-19 is higher (RR: 1.68, 95%CI: 1.26-2.22)[191]; however, another meta-analysis showed no association between viral hepatitis and poorer outcomes (pooled OR = 1.29, 95%CI: 0.36-4.63)[92]
Cirrhosis	Cirrhotic patients experienced more severe disease (pooled OR = 3.09, 95%CI, 1.95–4.89)[92]; Severity of cirrhosis associates with COVID-19 severity, as follows: Child-Pugh A cirrhosis OR: 1.90 (95%CI: 1.03-3.52); Child-Pugh B cirrhosis OR: 4.14 (95%CI: 2.4-7.65); Child-Pugh C cirrhosis OR: 9.32 (95%CI: 4.80-18.08)[111]
Liver transplant	No significant difference in mortality rates between LT and non-LT participants (OR: 0.8, 95%CI: 0.6-1.08); The time between the transplantation and COVID-19 did not affect the mortality rate (OR: 1.5, 95%CI: 0.63-3.56); Severe COVID-19 infection was observed in 23% of the participants with LT[129]
NAFLD	NAFLD was associated with more severe COVID-19 (AOR: 2.60, 95%CI: 2.24-3.02), more ICU admission (AOR: 1.66, 95%CI: 1.26-2.20), but not higher mortality rates (AOR: 1.01, 95%CI: 0.65-1.58)[148]
MAFLD	MAFLD increased the risk of severe COVID-19 (OR: 1.80, 95%CI: 1.53-2.13). No association was found between the presence of MAFLD and the occurrence of COVID-19 death[192]
Pregnancy	29.7% of pregnant patients with COVID-19 had liver injury; Liver injury can predispose pregnant females to experience more severe COVID-19, however, their neonates do not have worsen prognosis[157]

COVID-19: Coronavirus disease 2019; AIH: Autoimmune hepatitis; AOR: Adjusted odds ratio; CLD: Chronic liver disease; ICU: Intensive care unit; LT: Liver transplant; MAFLD: Metabolic associated fatty liver disease; MMF: Mycophenolate mofetil; NAFLD: Non-alcoholic fatty liver disease; OR: Odds ratio; RR: Relative risk.