Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.80
Peer-review started: May 13, 2021
First decision: July 18, 2021
Revised: July 28, 2021
Accepted: December 22, 2022
Article in press: December 22, 2021
Published online: January 27, 2022
Processing time: 253 Days and 7.2 Hours
Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.
Core Tip: Coronavirus disease-associated liver injury may occur in the progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with or without pre-existing liver disease. Patients with cirrhosis-associated immune dysfunction are particularly vulnerable. Strategies for management of sepsis and SARS are suggested in SARS-CoV-2 for intensive care patients, including early enteral nutrition soon after intensive care unit admission. Transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. In outpatient settings, micronutrient and ω-3 fatty acids have shown beneficial effects upon immune function and inflammation modulation and may be beneficial in management for SARS-CoV-2 liver patients.