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World J Clin Cases. Jun 6, 2021; 9(16): 3814-3825
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3814
COVID-19 impact on the liver
Liliana Baroiu, Caterina Dumitru, Alina Iancu, Ana-Cristina Leșe, Miruna Drăgănescu, Nicușor Baroiu, Lucreția Anghel
Liliana Baroiu, Miruna Drăgănescu, Lucreția Anghel, Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galati 800008, Romania
Caterina Dumitru, Pharmaceutical Sciences Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galati 800008, Romania
Alina Iancu, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galati 800008, Romania
Ana-Cristina Leșe, Design Department, Faculty of Visual Arts and Design, “George Enescu” National University of Arts, Iasi 700451, Romania
Nicușor Baroiu, Department of Manufacturing Engineering, Faculty of Engineering, “Dunarea de Jos” University of Galati, Galati 800008, Romania
Author contributions: Baroiu L and Dumitru C designed the research; Baroiu N and Anghel L analyzed the data; Baroiu L, Iancu A and Leșe AC wrote the paper; Drăgănescu M made critical revisions related to important content of the revised manuscript; Baroiu L, Dumitru C, Iancu A, Leșe AC, Drăgănescu M, Baroiu N and Anghel L provided the final approval of the version to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nicușor Baroiu, PhD, Associate Professor, Department of Manufacturing Engineering, Faculty of Engineering, “Dunarea de Jos” University of Galati, 47 Domneasca St., Galati 800008, Romania. nicusor.baroiu@ugal.ro
Received: February 4, 2021
Peer-review started: February 4, 2021
First decision: March 14, 2021
Revised: March 28, 2021
Accepted: April 29, 2021
Article in press: April 29, 2021
Published online: June 6, 2021
Processing time: 98 Days and 14.4 Hours
Abstract

The coronavirus disease 2019 (COVID-19) pandemic imposed arestructuring of global health systems by rethinking spaces used for the care of these patients and the additions of intensive care, infectious diseases and pneumology departments. This paper provides evidence on the presence of severe acute respiratory syndrome coronavirus 2 in hepatocytes and its direct cytopathic activity, as well as the degree of liver damage due to drug toxicity, inflammation and hypoxia in COVID-19. A review of clinical trials has quantified liver damage through both pathology and biochemistry studies. Additionally, we briefly present the results of a study conducted in our clinic on 849 patients admitted for COVID-19 treatment, of which 31 patients had pre-existing chronic liver disease and 388 patients had values above the normal limit for alanine aminotransferase, aspartate aminotransferase, and total bilirubin. It was observed that patients with abnormal liver tests were significantly statistically older, had more comorbidities and had a higher percentage of unfavourable evolution (death or transfer to intensive care). The conclusion of this paper is that the main causes of liver damage are direct viral aggression, coagulation dysfunction and endothelial damage, and patients with impaired liver function develop more severe forms of COVID-19 which requires special care by a multidisciplinary team that includes a hepatologist.

Keywords: COVID-19; Liver injury; Cytopathic effect; Hyper-inflammatory reaction; Drug toxicity; Biochemical changes

Core Tip: The lung damage of these patients is primordial in the cascade of care that they receive, but also the liver damage induced by the direct action of the virus and the toxicity of the medication administered, has determined the active involvement of hepatologists in the care of these patients. The present paper aims to summarize the data published so far and personal experience, which may clarify the extent of liver damage in coronavirus disease 2019 and effective ways of therapeutic approach.