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World J Gastroenterol. Jan 28, 2023; 29(4): 656-669
Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.656
COVID-19 and the liver: Are footprints still there?
Tarana Gupta, Hemant Sharma
Tarana Gupta, Hemant Sharma, Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
Author contributions: Gupta T wrote the paper and critically analysed the manuscript; and Sharma H collected the data and conducted the literature review.
Conflict-of-interest statement: There are 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: Tarana Gupta, Doctor, MBBS, MD, Professor, Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Medical Mor, Rohtak 124001, Haryana, India. taranagupta@gmail.com
Received: September 13, 2022
Peer-review started: September 13, 2022
First decision: September 29, 2022
Revised: October 13, 2022
Accepted: November 21, 2022
Article in press: November 21, 2022
Published online: January 28, 2023
Processing time: 128 Days and 21.1 Hours
Abstract

The coronavirus disease 2019 (COVID-19) hit the entire world as a global pandemic and soon became the most important concern for all patients with chronic diseases. An early trend in higher mortality in patients with acute respiratory distress attracted all researchers to closely monitor patients for the involvement of other systems. It soon became apparent that patients with chronic liver diseases are at increased risk of mortality given their cirrhosis-associated immune dysfunction. Additionally, liver function abnormalities were noted in patients with severe COVID-19. Profound cytokine storm, direct viral infection, drugs and reactivation of viral infections were causes of deranged liver functions. Here, we discuss the relation between COVID-19 and chronic liver disease, specifically cirrhosis, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease (NAFLD), as well as the liver manifestations of COVID-19. The metabolic syndrome, obesity, diabetes mellitus and NAFLD were found to worsen outcome in different studies reported worldwide. Decompensated cirrhosis should be considered a risk factor for death and severe COVID-19. Recently, COVID-19 related cholangiopathy has also been reported with changes of secondary sclerosing cholangitis. The long-term persistence of viral antigens in gut epithelia raises concern regarding the future risk of autoimmune liver diseases.

Keywords: COVID-19; Chronic liver disease; Cirrhosis; Liver injury; Transaminases; Non-alcoholic fatty liver disease; Post-acute COVID-19 syndrome

Core Tip: Coronavirus disease 2019 (COVID-19) and liver involvement have been a major concern since the beginning of the COVID-19 pandemic. Deranged liver functions with raised transaminases were reported in patients with severe COVID-19. On the other hand, acute hepatitis or liver failure was uncommon. Severe acute respiratory syndrome coronavirus 2 virus associated cytokine surge, systemic inflammation, direct viral infection, drugs such as remdesivir, steroids, and lopinavir-ritonavir were the main causative factor in raised transaminases. Patients with pre-existing chronic liver diseases especially non-alcoholic fatty liver disease were found to be risk factors for increased mortality in patients with severe COVID-19.