COVID-19 and liver injury: where do we stand?

The coronavirus SARS-CoV-2 was identified as the cause of COVID-19, a severe acute respiratory syndrome. Several clinical studies refer to liver injury as the most frequent clinical extrapulmonary manifestation. In this review, we summarize the available clinical data concerning liver injury during COVID-19. Although the underlying mechanism of liver impairment is somewhat unclear, transaminases and bilirubin levels are elevated in a substantial proportion of patients. Moreover, more severe alterations in liver enzymes may correlate with a worse clinical course of COVID-19. However, several other cofactors, such as drug-induced liver injury, hyper-inflammatory response to infection, hypoxic hepatitis or preexisting underlying liver disease, cannot be excluded.