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Pathophysiological mechanisms of liver injury in COVID-19

Alexander D Nardo1, Mathias Schneeweiss-Gleixner2, May Bakail3

  • 1Hans Popper Laboratory of Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

Liver International : Official Journal of the International Association for the Study of the Liver
|November 15, 2020
PubMed

Insights

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) can cause liver injury in COVID-19 patients. This liver involvement may indicate disease severity and predict acute respiratory distress syndrome (ARDS).

Area of Science:

  • Hepatology
  • Virology
  • Pulmonology

Background:

  • Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to a global pandemic.
  • Acute respiratory distress syndrome (ARDS) is a primary cause of mortality in COVID-19 patients.
  • Hepatic involvement in COVID-19, while not causing liver failure without pre-existing conditions, correlates with disease severity and ARDS prognosis.

Purpose of the Study:

  • To review the pathophysiological mechanisms of SARS-CoV-2 hepatic tropism.
  • To discuss the spectrum of acute and potential long-term liver injury in COVID-19.
  • To explore the relationship between COVID-19 and liver dysfunction.

Main Methods:

  • Literature review of studies on COVID-19 and liver injury.
  • Analysis of potential mechanisms including direct viral infection, systemic inflammation, hypoxia, and iatrogenic factors.
  • Synthesis of current understanding of SARS-CoV-2's impact on the liver.

Main Results:

  • SARS-CoV-2 can affect the liver through various pathways.
  • Liver injury in COVID-19 ranges from direct infection to indirect effects of systemic illness.
  • Hepatic involvement serves as a potential prognostic marker for ARDS development.

Conclusions:

  • COVID-19 can lead to diverse forms of liver injury.
  • Understanding SARS-CoV-2's hepatic tropism is crucial for patient management.
  • Further research is needed to fully elucidate long-term hepatic consequences of COVID-19.

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