Spectrum of COVID-19 induced liver injury: A review report

Table 1 Future directions and preventative strategies for coronavirus disease 2019

Aspect	Actions
Prevention	Monitor liver biochemical markers (ALT/AST, bilirubin, prothrombin time and albumin, prothrombin time) to detect liver damage
	Differentiate liver injury from other conditions (e.g., skeletal muscle or myocardial damage)
	Focus on the treatment of pre-existing patients with liver disease
	Consider continuation of antiviral medications for chronic hepatitis B to prevent reactivation
	Consider anti-HBV medications for patients receiving glucocorticoid therapy
	Cautiously monitor the COVID-19 course in patients with autoimmune liver disease on glucocorticoids or immunosuppressants
	Intensively monitor individuals with cirrhosis for complications and secondary infections due to immunocompromised state
	Reduce the risk of drug-induced liver impairment by streamlining the treatment and avoiding redundant pharmaceutical types, doses, and durations
Management	Provide intensive care and supportive therapies to prevent and treat patients with multiple organ failure, including liver damage
	Correct hypoxemia with oxygenation support or mechanical ventilation
	Continuous renal replacement therapy for cytokine storm syndrome
	Maintain adequate blood volume
	Monitor liver enzymes and other liver function markers regularly
Implications	The COVID-19 pandemic has impacted the management of CLD and delayed screening and follow-up appointments
Future directions	Social isolation practices may lead to decompensation, mental health impairment, and malnutrition in CLD patients
	COVID-19 can cause liver damage, potentially through direct harm, immune-mediated hepatotoxicity, or cytokine storm
	Liver involvement may be associated with the severity of COVID-19
	Obesity and comorbid conditions like diabetes or hypertension increase the risk of liver disease and worsen SARS-CoV-2 infection
	Liver dysfunction is a potential risk factor for mortality in COVID-19 patients
	Liver cells may be directly infected by SARS-CoV-2, leading to liver dysfunction
	Histological characteristics of liver infection include significant apoptosis and binuclear hepatocytes

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CLD: Chronic liver disease; COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.