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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6178-6200
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6178
COVID-19 infection and liver injury: Clinical features, biomarkers, potential mechanisms, treatment, and management challenges
Gholam Reza Sivandzadeh, Hassan Askari, Ali Reza Safarpour, Fardad Ejtehadi, Ehsan Raeis-Abdollahi, Armaghan Vaez Lari, Mohammad Foad Abazari, Firoozeh Tarkesh, Kamran Bagheri Lankarani
Gholam Reza Sivandzadeh, Hassan Askari, Ali Reza Safarpour, Fardad Ejtehadi, Firoozeh Tarkesh, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
Ehsan Raeis-Abdollahi, Department of Medical Sciences, Qom Medical Branch, Islamic Azad University, Qom 1417613151, Iran
Armaghan Vaez Lari, Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz 6135715794, Iran
Mohammad Foad Abazari, Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran 1417653761, Iran
Kamran Bagheri Lankarani, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
Author contributions: Safarpour AR, Raeis-Abdollahi E, Vaez Lari A, Abazari MF, Ejtehadi F, and Tarkesh F collected data; Sivandzadeh GR, Askari H, and Safarpour AR collected data and partly drafted the paper's first version; Sivandzadeh GR, Askari H, Safarpour AR and Bagheri Lankarani K designed, revised, and finalized the manuscript.
Conflict-of-interest statement: The authors declare 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Reza Safarpour, MD, PhD, Assistant Professor, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz 7193635899, Iran. safarpourar@gmail.com
Received: January 18, 2021
Peer-review started: January 18, 2021
First decision: May 2, 2021
Revised: May 7, 2021
Accepted: June 25, 2021
Article in press: June 25, 2021
Published online: August 6, 2021
Processing time: 190 Days and 21 Hours
Abstract

It is hypothesized that liver impairment caused by coronavirus disease 2019 (COVID-19) infection might play a central role in severe clinical presentations. Liver injury is closely associated with severe disease and, even with antiviral drugs, have a poor prognosis in COVID-19 patients. In addition to the common hepatobiliary disorders caused by COVID-19, patients with pre-existing liver diseases demand special considerations during the current pandemic. Thus, it is vital that upon clinical presentation, patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure. Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases, particularly in those with pre-existing metabolic liver injury. The purpose of this study was to determine most recent evidence regarding causality, potential risk factors, and challenges, therapeutic options, and management of COVID-19 infection in vulnerable patients with pre-existing liver injury. This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.

Keywords: Liver injury; COVID-19; SARS-CoV-2; Inflammation; Management

Core Tip: Coronavirus disease 2019 (COVID-19) is associated with respiratory symptoms, digestive complications, and liver injury. Severe inflammatory response, anoxia, drug-induced liver injury, direct cytotoxicity, as well as reactivation of pre-existing liver disease might be the etiologic mechanisms behind liver injury in COVID-19 patients. In this review, we study the clinical manifestations and liver-related events seen in COVID-19 patients, including the pathophysiology, etiology, biomarkers, diagnosis, treatment, and management strategies for liver injury. We aim to increase the awareness of healthcare workers about liver injury and to provide information for hepatic management in COVID-19 patients. Physicians should (1) pay special attention to the management of concurrent liver disorders; (2) boost hepatic function by strengthening supportive therapy; and (3) minimize the risk of drug-induced liver injury.