Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury

Figure 1 Potential mechanisms of liver injury in patients with coronavirus disease 2019. 1: Severe acute respiratory syndrome coronavirus-2 may directly bind to angiotensin converting enzyme II positive cholangiocytes to dysregulate liver function; 2: Inflammatory cytokine storm leads to persistent activation of lymphocytes and macrophages that secrete huge amount of inflammatory cytokine, thus contributing to lung as well as liver damage; 3: Drugs including antipyretics, antiviral medications (lopinavir/ritonavir), antibiotics (macrolides, quinolones) and steroids may have potential hepatotoxicity and lead to abnormal liver function; 4: Hepatic ischemia and hypoxia-reperfusion dysfunction induced by complications such as respiratory failure may cause liver damage, especially in critically ill patients.