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World J Virol. Nov 25, 2022; 11(6): 435-442
Published online Nov 25, 2022. doi: 10.5501/wjv.v11.i6.435
Cholestatic liver injury: A rare but fatal complication during and after COVID-19 infection
Wachira Wongtanasarasin
Wachira Wongtanasarasin, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Wachira Wongtanasarasin, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, United States
Author contributions: Wongtanasarasin W designed the protocol, contributed to data collection, data evaluation, data visualization, wrote the first draft of the manuscript, and critically reviewed the final version of the manuscript.
Conflict-of-interest statement: The author declares that they have no competing interests.
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: Wachira Wongtanasarasin, MD, Assistant Professor, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Intavarorot Street, Sriphum, Chiang Mai 50200, Thailand. wachir_w@hotmail.com
Received: August 9, 2022
Peer-review started: August 9, 2022
First decision: August 29, 2022
Revised: September 21, 2022
Accepted: October 19, 2022
Article in press: October 19, 2022
Published online: November 25, 2022
Processing time: 105 Days and 16.6 Hours
Abstract

The 2019 coronavirus disease (COVID-19), resulting from the severe acute respiratory syndrome 2 virus, has transformed our globe and provided a new perspective on respiratory tract infections. However, COVID-19 would not be recognized as a condition restricted to only pneumonia. This narrative review was conducted by searching manuscripts in several databases, including PubMed/ MEDLINE, Web of Science, and Reference Citation Analysis, from December 2019 to July 2022. Many studies have revealed a broad spectrum of potential systemic symptoms, including biliary complications. Although biliary injury has been observed in a very low proportion of COVID-19 patients, it is associated with increased mortalities and long-term morbidities. We identify a cholangiopathy condition in individuals during infection and after recovering from severe COVID-19, defined by a significant increase in serum alkaline phosphatase and signs of bile duct injury. Understanding the pathogeneses behind this condition would help us develop new techniques to prevent these complications. This review thoroughly discusses and summarizes the current information regarding COVID-19-associated cholangiopathy. In addition, the possible explanations for COVID-19-associated cholangiopathy are presented. Since the exact pathogenesis may not be concluded, this review could provide relevant information to encourage additional investigations shortly.

Keywords: COVID-19; Cholestatic injury; Cholangiopathy; Alkaline phosphatase

Core Tip: The 2019 coronavirus disease (COVID-19) is not only regarded as a respiratory tract disease but also demonstrates a wide range of systemic consequences, including the biliary tract. A significant increase in serum alkaline phosphatase and signs of biliary injury on imaging and/or pathology are the hallmarks of COVID-19-associated cholangiopathy. Direct viral invasion, ischemic injury related to microvascular coagulopathy, drug-induced cholestatic liver injury, alteration of gut microbiota, and cytokine release syndrome are proposed as potential explanations for cholangiopathy associated with severe COVID-19 infection.