Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.413
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.
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.