Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2020; 12(8): 413-422
Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.413
Mechanisms and consequences of COVID-19 associated liver injury: What can we affirm?
Carlos Antunes Brito, Fabio Marinho Barros, Edmundo Pessoa Lopes
Carlos Antunes Brito, Edmundo Pessoa Lopes, Department of Internal Medicine, Center of Medical Sciences of Federal University of Pernambuco, Recife, Pernambuco 50740600, Brazil
Carlos Antunes Brito, Edmundo Pessoa Lopes, Clinical Hospital of Federal University of Pernambuco, Recife, Pernambuco 50740900, Brazil
Carlos Antunes Brito, Edmundo Pessoa Lopes, Post-graduation Program of Tropical Medicine of Federal University of Pernambuco, Recife, Pernambuco 50670901, Brazil
Carlos Antunes Brito, Autoimmune Research Institute, Recife, Pernambuco 52011010, Brazil
Fabio Marinho Barros, Português Hospital of Pernambuco, Recife, Pernambuco 52010075, Brazil
Author contributions: All contributing authors participated in the study to the conception or design of the work or the acquisition, analysis or interpretation of the papers and subsequent revisions of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Carlos Alexandre Brito, MD, MSc, PhD, Adjunct Professor, Internal Medicine Department, Center of Medical Sciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235-Cidade Universitária, Recife, Pernambuco 50740600, Brazil. carlos.brito@ufpe.br
Received: May 14, 2020
Peer-review started: May 14, 2020
First decision: June 2, 2020
Revised: June 5, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: August 27, 2020

Since the first reports of coronavirus disease 2019 (COVID-19) cases in December 2019 in China, numerous papers have been published describing a high frequency of liver injury associated with severe acute respiratory syndrome coronavirus 2 infection, many of them proposing a link between these findings and patient outcomes. Increases in serum aminotransferase levels (ranging from 16% to 62%) and bilirubin levels (ranging from 5% to 21%) have been reported and seem to be more often observed in patients with severe forms of COVID-19. Although absolute changes in these parameters are frequently seen, other variables, such as the ratio above the upper limit of normal, the onset of liver injury as a complication in severe cases and histopathological findings, reinforce that liver changes are of dubious clinical relevance in the course of this disease. Other factors must also be considered in these analyses, such as the repercussions of hemodynamic changes, the presence of thrombotic events, and, mainly, the possible drug-induced liver injury with the current, yet off-label, treatment. This paper aimed to analyze the currently available data on liver injury in patients with COVID-19.

Keywords: COVID-19, SARS-CoV-2, Liver injury, Liver enzymes, Drug induced liver injury, Pandemic

Core tip: The coronavirus disease 2019 (COVID-19) pandemic has affected millions worldwide, with high lethality. Papers have been describing liver injury but with divergent results; some have suggested a positive relationship between liver involvement and severity of infection. To evaluate this matter, some aspects, such as the frequency and severity of liver enzyme abnormalities, should be analyzed according to clinical and histopathological findings; other associated factors, such as interactions with the drugs used in COVID-19 treatment, should be analyzed as well. An overview of the aspects related to liver injury during COVID-19 infection was analyzed in this study according to evidence known to date.