COVID-19 and comorbidities of hepatic diseases in a global perspective

Abstract

The worldwide outbreak of coronavirus disease 2019 (COVID-19) has challenged the priorities of healthcare system in terms of different clinical management and infection transmission, particularly those related to hepatic-disease comorbidities. Epidemiological data evidenced that COVID-19 patients with altered liver function because of hepatitis infection and cholestasis have an adverse prognosis and experience worse health outcomes. COVID-19-associated liver injury is correlated with various liver diseases following a severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) infection that can progress during the treatment of COVID-19 patients with or without pre-existing liver disease. SARS-CoV-2 can induce liver injury in a number of ways including direct cytopathic effect of the virus on cholangiocytes/hepatocytes, immune-mediated damage, hypoxia, and sepsis. Indeed, immediate cytopathogenic effects of SARS-CoV-2 via its potential target, the angiotensin-converting enzyme-2 receptor, which is highly expressed in hepatocytes and cholangiocytes, renders the liver as an extra-respiratory organ with increased susceptibility to pathological outcomes. But, underlying COVID-19-linked liver disease pathogenesis with abnormal liver function tests (LFTs) is incompletely understood. Hence, we collated COVID-19-associated liver injuries with increased LFTs at the nexus of pre-existing liver diseases and COVID-19, and defining a plausible pathophysiological triad of COVID-19, hepatocellular damage, and liver disease. This review summarizes recent findings of the exacerbating role of COVID-19 in pre-existing liver disease and vice versa as well as international guidelines of clinical care, management, and treatment recommendations for COVID-19 patients with liver disease.

Keywords: Liver disease; COVID-19; Pathophysiology; Epidemiology; Prophylaxis

Core Tip: The clinical menace of coronavirus disease 2019 (COVID-19)-related comorbidities of hepatic diseases and severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) tropism for the liver result in liver impairment with increased liver injury markers and cytokine storm. SARS-CoV-2 aggravates liver injury via coagulative and fibrinolytic pathways, cytokine-mediated liver injury, ischemia-hypoxia, and immune-mediated cell death pathways owing to adverse outcomes of liver disease such as nonalcoholic steatohepatitis, drug-induced liver injury, nonalcoholic fatty liver disease, metabolic associated fatty liver disease, and hepatocellular carcinoma. This review summarizes diagnostic approaches, therapeutics, clinical guidelines, and vaccines for COVID-19 and liver disease comorbidities.