Liver Injury in COVID-19 Infection: A Systematic Review

Area of Science:

• Hepatology
• Infectious Diseases
• Internal Medicine

Background:

• The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to widespread illness, with reported involvement of multiple organs beyond the respiratory tract, including the liver.
• The prevalence and clinical significance of liver enzyme derangement in COVID-19 patients remain unclear.
• Uncertainty exists regarding the progression of liver injury and the risk of liver failure in COVID-19 cases with elevated liver enzymes.

Purpose of the Study:

• To determine if liver enzyme derangement is a common feature in adult COVID-19 patients.
• To investigate the relationship between abnormal liver enzymes and patient outcomes, including mortality, in COVID-19.
• To assess the frequency of liver failure as a complication of COVID-19.

Main Methods:

• A systematic literature review was conducted using PubMed and OVID Medline databases.
• Included studies were cross-sectional or case-control involving adult COVID-19 patients with available liver enzyme data.
• Data extraction was performed independently by two authors, with additional studies identified via the LitCovid search hub.

Main Results:

• Analysis of seven eligible studies revealed that many COVID-19 patients exhibited varying degrees of liver enzyme derangement.
• The observed liver injury was typically mild and appeared to correlate with the severity of the COVID-19 infection.
• Severe liver injury, liver failure, or fatal outcomes directly attributed to liver damage were uncommon.

Conclusions:

• Liver enzyme abnormalities are frequently observed in COVID-19 patients, generally presenting as mild elevations.
• The severity of liver enzyme derangement appears linked to the overall severity of COVID-19 illness.
• Significant liver damage leading to liver failure or death is rare in COVID-19 patients.