Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2021; 27(13): 1296-1310
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1296
COVID-19 and comorbidities of hepatic diseases in a global perspective
Aqsa Ahmad, Syeda Momna Ishtiaq, Junaid Ali Khan, Rizwan Aslam, Sultan Ali, Muhammad Imran Arshad
Aqsa Ahmad, Rizwan Aslam, Sultan Ali, Muhammad Imran Arshad, Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
Syeda Momna Ishtiaq, Junaid Ali Khan, Institute of Physiology and Pharmacology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
Author contributions: Ahmad A and Ishtiaq SM contributed literature review, wrote the manuscript and analyzed the data, and contributed equally to this work; Arshad MI and Khan JA conceived the idea, collected data and contributed to the writing of the article; Aslam R and Ali S proof-read the manuscript and contributed to data-mining and editing.
Conflict-of-interest statement: The authors declare no competing and financial conflict of interests.
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:
Corresponding author: Muhammad Imran Arshad, PhD, Assistant Professor, Institute of Microbiology, University of Agriculture Faisalabad, Main Agriculture University and Jail Road, Faisalabad 38040, Punjab, Pakistan.
Received: January 18, 2021
Peer-review started: January 18, 2021
First decision: February 9, 2021
Revised: February 17, 2021
Accepted: March 19, 2021
Article in press: March 19, 2021
Published online: April 7, 2021

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.