Zhao SW, Li YM, Li YL, Su C. Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments. World J Gastroenterol 2023; 29(2): 241-256 [PMID: 36687127 DOI: 10.3748/wjg.v29.i2.241]
Corresponding Author of This Article
Chen Su, MD, PhD, Assistant Professor, Doctor, Department of Anesthesiology and Pain, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, No. 283 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China. suchen@hnca.org.cn
Research Domain of This Article
Critical Care Medicine
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. Jan 14, 2023; 29(2): 241-256 Published online Jan 14, 2023. doi: 10.3748/wjg.v29.i2.241
Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments
Shu-Wu Zhao, Yi-Ming Li, Yi-Lin Li, Chen Su
Shu-Wu Zhao, Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, Hunan Province, China
Yi-Ming Li, School of Basic Medical Science, Naval Medical University/Second Military University, Shanghai 200433, China
Yi-Lin Li, Department of Pathology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, Hunan Province, China
Chen Su, Department of Anesthesiology and Pain, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, Hunan Province, China
Author contributions: Zhao SW performed the majority of the writing, prepared the figures and tables; Li YM performed data accusation and writing; Li YL provided the input in writing the paper; Su C designed the outline and coordinated the writing of the paper.
Supported bythe National Natural Science Foundation of China, No. 81901141; and the Scientific Research Project of Hunan Provincial Health Commission, No. 202204114480.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Chen Su, MD, PhD, Assistant Professor, Doctor, Department of Anesthesiology and Pain, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, No. 283 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China. suchen@hnca.org.cn
Received: September 14, 2022 Peer-review started: September 14, 2022 First decision: October 19, 2022 Revised: November 11, 2022 Accepted: December 8, 2022 Article in press: December 8, 2022 Published online: January 14, 2023
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been a serious threat to global health for nearly 3 years. In addition to pulmonary complications, liver injury is not uncommon in patients with novel COVID-19. Although the prevalence of liver injury varies widely among COVID-19 patients, its incidence is significantly increased in severe cases. Hence, there is an urgent need to understand liver injury caused by COVID-19. Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes. Liver function tests, computed tomography scans, and ultrasound can help evaluate liver injury. Risk factors for liver injury in patients with COVID-19 include male sex, preexisting liver disease including liver transplantation and chronic liver disease, diabetes, obesity, and hypertension. To date, the mechanism of COVID-19-related liver injury is not fully understood. Its pathophysiological basis can generally be explained by systemic inflammatory response, hypoxic damage, ischemia-reperfusion injury, and drug side effects. In this review, we systematically summarize the existing literature on liver injury caused by COVID-19, including clinical features, underlying mechanisms, and potential risk factors. Finally, we discuss clinical management and provide recommendations for the care of patients with liver injury.
Core Tip: A growing body of evidence suggests that patients with coronavirus disease 2019 (COVID-19) may experience varying degrees of liver injury. The characteristics and mechanisms of liver injury associated with COVID-19 are not fully understood. In this review, we summarized the clinical features, mechanisms, and management strategies of liver injury associated with COVID-19. Moreover, we collected all the information about high risk factors for liver injury from COVID-19, which is of significance and help for further study of liver damage related to severe acute respiratory syndrome coronavirus 2.
