Cooper KM, Colletta A, Asirwatham AM, Moore Simas TA, Devuni D. COVID-19 associated liver injury: A general review with special consideration of pregnancy and obstetric outcomes. World J Gastroenterol 2022; 28(42): 6017-6033 [PMID: 36405386 DOI: 10.3748/wjg.v28.i42.6017]
Corresponding Author of This Article
Katherine M. Cooper, MD, Doctor, Department of Medicine, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01605, United States. katherine.cooper@umassmed.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 14, 2022; 28(42): 6017-6033 Published online Nov 14, 2022. doi: 10.3748/wjg.v28.i42.6017
COVID-19 associated liver injury: A general review with special consideration of pregnancy and obstetric outcomes
Katherine M. Cooper, Alessandro Colletta, Alison M. Asirwatham, Tiffany A. Moore Simas, Deepika Devuni
Katherine M. Cooper, Alessandro Colletta, Deepika Devuni, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
Alison M. Asirwatham, Tiffany A. Moore Simas, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
Tiffany A. Moore Simas, Departments of Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
Deepika Devuni, Division of Gastroenterology and Hepatology, University of Massachusetts Chan Medical School, Worcester, MA 1605, United States
Author contributions: Cooper KM conceptualized this article, completed research collection, and lead the writing and editing of the manuscript; Colletta A assisted in conceptualizing the article, wrote portions of the manuscript, edited the initial, and revised manuscripts; Asirwatham AM assisted in conceptualizing portions of the article and provided expert feedback in the area of Obstetrics and Gynecology; Moore Simas TA reviewed content, edited the initial and revised manuscript, and provided expert feedback in the area of Obstetrics and Gynecology; Devuni D reviewed content, edited the initial and revised manuscript, and provided expert feedback in the area of Hepatology.
Conflict-of-interest statement: Devuni D is an Associate Professor of Medicine at UMass Chan Medical School, she has received grant funding from Sequana Medical for a clinical trial unrelated to the present work; all other authors have no conflicts of interest to report.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Katherine M. Cooper, MD, Doctor, Department of Medicine, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01605, United States. katherine.cooper@umassmed.edu
Received: September 12, 2022 Peer-review started: September 12, 2022 First decision: October 19, 2022 Revised: October 24, 2022 Accepted: October 27, 2022 Article in press: October 27, 2022 Published online: November 14, 2022
Abstract
Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Coronavirus disease 2019 (COVID-19) associated liver injury (COVALI) is a clinical syndrome encompassing all patients with biochemical liver injury identified in the setting of SARS-CoV-2 infection. Despite profound clinical implications, its pathophysiology is poorly understood. Unfortunately, most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research, including pregnant individuals. This manuscript reviews: Clinical features of COVALI, leading theories of COVALI, and existing literature on COVALI during pregnancy, a topic not widely explored in the literature. Ultimately, we synthesized data from the general and perinatal populations that demonstrates COVALI to be a hepatocellular transaminitis that is likely induced by systemic inflammation and that is strongly associated with disease severity and poorer clinical outcome, and offered perspective on approaching transaminitis in the potentially COVID-19 positive patient in the obstetric setting.
Core Tip: Liver injury is an increasingly recognized extra-pulmonary manifestation of coronavirus disease 2019 (COVID-19). COVID-19 associated liver injury (COVALI) is a clinical syndrome encompassing all patients with COVID-19 infection and biochemical liver injury. Unfortunately, most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research, including pregnant individuals. In this review we summarize clinical features of COVALI and the leading theories of pathophysiology and present existing literature on COVALI during pregnancy, a topic not widely explored in the literature.
