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World J Gastroenterol. Dec 21, 2022; 28(47): 6716-6731
Published online Dec 21, 2022. doi: 10.3748/wjg.v28.i47.6716
Liver injury in COVID-19: A minireview
Wen-Shu Hu, Fang-Ying Jiang, Wen Shu, Rong Zhao, Ji-Min Cao, De-Ping Wang
Wen-Shu Hu, Fang-Ying Jiang, Wen Shu, Rong Zhao, Ji-Min Cao, Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Wen-Shu Hu, Fang-Ying Jiang, Wen Shu, Rong Zhao, Ji-Min Cao, De-Ping Wang, Department of Physiology, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Hu WS and Jiang FY contributed equally to this work; Hu WS, Jiang FY, Shu W, and Zhao R reviewed prior publications and drafted the manuscript; Cao JM and Wang DP revised the paper.
Supported by the Key Medical Science and Technology Program of Shanxi Province, No. 2020XM01; Shanxi “1331” Project Quality and Efficiency Improvement Plan, No. 1331KFC; Applied Basic Research Program of Shanxi Province, No. 202103021224234; and National Natural Science Foundation of China, No. 82170523.
Conflict-of-interest statement: The authors declare no conflicts of interest for this work.
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: De-Ping Wang, PhD, Lecturer, Department of Physiology, Shanxi Medical University, No. 56 Xinjian Nan Road, Taiyuan 030001, Shanxi Province, China.
Received: September 12, 2022
Peer-review started: September 12, 2022
First decision: October 19, 2022
Revised: November 2, 2022
Accepted: November 22, 2022
Article in press: November 22, 2022
Published online: December 21, 2022

Coronavirus disease 2019 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has escalated into a global tragedy afflicting human health, life, and social governance. Through the increasing depth of research and a better understanding of this disease, it has been ascertained that, in addition to the lungs, SARS-CoV-2 can also induce injuries to other organs including the liver. Liver injury is a common clinical manifestation of COVID-19, particularly in severe cases, and is often associated with a poorer prognosis and higher severity of COVID-19. This review focuses on the general existing information on liver injury caused by COVID-19, including risk factors and subpopulations of liver injury in COVID-19, the association between preexisting liver diseases and the severity of COVID-19, and the potential mechanisms by which SARS-CoV-2 affects the liver. This review may provide some useful information for the development of therapeutic and preventive strategies for COVID-19-associated liver injury.

Keywords: Liver, SARS-CoV-2, Angiotensin-converting enzyme 2, Transmembrane serine protease 2, Chronic liver disease

Core Tip: The global pandemic of coronavirus disease 2019 (COVID-19) has imposed a great threat to human health and become a medical and social challenge. Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mainly affects the respiratory tract, it also frequently damages the liver especially in severe and critical cases. Direct hepatotoxicity of SARS-CoV-2, or indirect hepatic injury caused by immune overactivation and systemic inflammation, drug-induced injury, ischemia/reperfusion and hypoxia/reoxygenation injuries, and worsening of preexisting liver diseases, are potential contributing factors to liver damage in COVID-19.