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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2023; 29(2): 257-271
Published online Jan 14, 2023. doi: 10.3748/wjg.v29.i2.257
COVID-19 and liver injury: An ongoing challenge
Ioanna Papagiouvanni, Serafeim-Chrysovalantis Kotoulas, Athanasia Pataka, Dionisios G Spyratos, Konstantinos Porpodis, Afroditi K Boutou, Georgios Papagiouvannis, Ioanna Grigoriou, Christos Vettas, Ioannis Goulis
Ioanna Papagiouvanni, Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Thessaloniki, Greece
Serafeim-Chrysovalantis Kotoulas, Intensive Care Unit, Hippokration General Hospital, Thessaloniki 54642, Greece
Athanasia Pataka, Department of Respiratory Medicine, G Papanikolaou Hospital, Resp Failure Unit, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
Dionisios G Spyratos, Konstantinos Porpodis, Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
Afroditi K Boutou, Pulmonary Department, G Papanikolaou Hospital, Resp Failure Unit, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Georgios Papagiouvannis, Department of Pharmacy, School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
Ioanna Grigoriou, Respiratory Failure Clinic, Papanikolaou General Hospital, Thessloniki 57001, Greece
Christos Vettas, Ioannis Goulis, Fourth Department of Internal Medicine, Hippokration General Hospital, Thessaloniki 54642, Greece
Author contributions: Papagiouvanni I, Kotoulas SC, Pataka A, Spyratos D, Porpodis K, Boutou A, Papagiouvannis G, Grigoriou I, Vettas C, and Goulis I contributed equally to this work; all authors have read and approve the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests 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: Ioanna Papagiouvanni, MSc, Doctor, Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, 49 Konstantinoupoleos, Thessaloniki 54642, Thessaloniki, Greece. ioanna.d.pap@gmail.com
Received: September 12, 2022
Peer-review started: September 12, 2022
First decision: November 15, 2022
Revised: November 29, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 14, 2023
The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in December 2019, in Wuhan, China. The virus was rapidly spread worldwide, causing coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is presented, usually, with typical respiratory symptoms (i.e., dyspnea, cough) and fever, extrapulmonary manifestations are also encountered. Liver injury is a common feature in patients with COVID-19 and ranges from mild and temporary elevation of liver enzymes to severe liver injury and, even, acute liver failure. The pathogenesis of liver damage is not clearly defined; multiple mechanisms contribute to liver disorder, including direct cytopathic viral effect, cytokine storm and immune-mediated hepatitis, hypoxic injury, and drug-induced liver toxicity. Patients with underlying chronic liver disease (i.e., cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID-19 and further liver deterioration, and, as a consequence, certain issues should be considered during disease management. The aim of this review is to present the prevalence, clinical manifestation and pathophysiological mechanisms of liver injury in patients with SARS-CoV-2 infection. Moreover, we overview the association between chronic liver disease and SARS-CoV-2 infection and we briefly discuss the management of liver injury during COVID-19.
Core Tip: Liver injury is a common feature in coronavirus disease 2019 (COVID-19) patients and was associated with disease severity and prognosis. Multiple pathophysiological mechanisms are responsible for liver injury, including direct viral effect, cytokine storm, hypoxia and drug hepatotoxicity, however, further research is needed, in order, for them, to be clearly defined. Patients with underlying chronic liver disease may be more susceptible to severe acute respiratory syndrome coronavirus 2 infection; nevertheless, evidence is still limited. It is necessary to know the mechanisms of liver injury, the clinical manifestations and the effect of COVID-19 in underlying liver disease, in order to design appropriate management programs.
