Bitar R, Elghoudi AA, Rawat D, Azaz A, Miqdady M, Narchi H. COVID-19-induced liver injury in infants, children, and adolescents. World J Clin Pediatr 2023; 12(3): 57-67 [PMID: 37342451 DOI: 10.5409/wjcp.v12.i3.57]
Corresponding Author of This Article
Ahmed A Elghoudi, MBChB, MSc, Adjunct Associate Professor, Doctor, Department of Pediatric, Sheikh Khalifa Medical City, Al Karama Street, Al Khalidya, Abu Dhabi, United Arab Emirates. aelghoudi@seha.ae
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Clin Pediatr. Jun 9, 2023; 12(3): 57-67 Published online Jun 9, 2023. doi: 10.5409/wjcp.v12.i3.57
COVID-19-induced liver injury in infants, children, and adolescents
Rana Bitar, Ahmed A Elghoudi, David Rawat, Amer Azaz, Mohamad Miqdady, Hassib Narchi
Rana Bitar, David Rawat, Amer Azaz, Mohamad Miqdady, Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
Rana Bitar, David Rawat, Amer Azaz, Mohamad Miqdady, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
Ahmed A Elghoudi, Department of Pediatric, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
Ahmed A Elghoudi, Hassib Narchi, Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Author contributions: All the authors contributed equally to writing the manuscript and reviewing the final draft.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
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: Ahmed A Elghoudi, MBChB, MSc, Adjunct Associate Professor, Doctor, Department of Pediatric, Sheikh Khalifa Medical City, Al Karama Street, Al Khalidya, Abu Dhabi, United Arab Emirates. aelghoudi@seha.ae
Received: September 27, 2022 Peer-review started: September 27, 2022 First decision: October 17, 2022 Revised: November 7, 2022 Accepted: March 17, 2023 Article in press: March 17, 2023 Published online: June 9, 2023 Processing time: 251 Days and 18.7 Hours
Abstract
Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms in children. Most children develop an asymptomatic and mild illness, with a minority requiring specialist medical care. Gastrointestinal manifestations and liver injury can also occur in children following infection. The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion, immune response, or medication effects. Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease. However, the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes. On the other hand, the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor. Respiratory, hemodynamic, and nutritional supportive therapies are the mainstay of management. Vaccination of children at increased risk of developing severe COVID-19 disease is indicated. This review describes the liver manifestations in children with COVID-19, detailing its epidemiology, basic mechanisms, clinical expression, management, and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.
Core Tip: Liver injury presenting with elevated levels of alanine aminotransferase and aspartate aminotransferase is common in children infected with the coronavirus disease 2019 (COVID-19) virus. The mechanism of liver injury is not fully understood and is likely secondary to the viral invasion of the liver, hepato-toxic medications, and the patient’s own immune-mediated response. Liver injury in children is generally mild and resolves spontaneously but is usually seen in children with more severe illnesses. In addition, children with underlying non-alcoholic fatty liver disease or another chronic liver disease may have a higher risk of severe COVID-19 illness. Management of liver injury after COVID infection is supportive. Proactive vaccination may reduce the transmission of infection and the severity of the disease.
