COVID-19-related liver injury: Focus on genetic and drug-induced perspectives

Table 3 Mechanism of hepatic damage in severe acute respiratory syndrome coronavirus 2 infection

Proposed main mechanism	Explanation
Direct cytotoxicity	Active SARS-CoV-2 replication in hepatic cells, which further binds to hepatic and biliary epithelial cells by angiotensin-converting enzyme 2 and damage them by direct infection[57]
Immunological damage	Severe inflammatory response generated by SARS-CoV-2 further damages hepatic cells by immune mediated pathogenesis[58]
Drug-induced	Antiviral drugs such as remdesivir, chloroquine and ritonavir are possibly hepatotoxic[59]
Reactivation of pre-existing liver illness	Increased risk to develop hepatotoxicity in the presence of pre-existing liver diseases. In addition, baricitinib also causes reactivation of hepatitis B virus infection[60]
Anoxia	Anoxia or hypoxia leads to respiratory failure in SARS-CoV-2, which further leads to hypoxic hepatitis[61]

SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.