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Coronavirus Disease-2019 (COVID-19) and the Liver

Anshuman Elhence1, Manas Vaishnav1, Sagnik Biswas1

  • 1Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.

Journal of Clinical and Translational Hepatology
|May 19, 2021
PubMed

Insights

Coronavirus disease-2019 (COVID-19) causes gastrointestinal and liver issues via ACE-2 receptors. Immunosuppressed patients, including liver transplant recipients, show surprisingly good outcomes despite COVID-19.

Area of Science:

  • Hepatology
  • Virology
  • Gastroenterology

Background:

  • Coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, is a global pandemic.
  • Beyond respiratory symptoms, COVID-19 presents with diverse gastrointestinal and liver manifestations.
  • The angiotensin-converting enzyme-2 (ACE-2) receptor, expressed in the GI tract and liver, is implicated in SARS-CoV-2 infection.

Purpose of the Study:

  • To review the spectrum of gastrointestinal and liver manifestations of COVID-19.
  • To explore the role of ACE-2 receptors and immune response in COVID-19 pathogenesis.
  • To analyze the impact of COVID-19 on patients with pre-existing liver conditions and outcomes in immunosuppressed individuals.

Main Methods:

  • Literature review of studies on COVID-19 and its hepatic/gastrointestinal effects.
  • Analysis of reported cases and clinical data regarding liver function test abnormalities.
  • Examination of outcomes in specific patient groups, including those with chronic liver disease and transplant recipients.

Main Results:

  • Approximately 50% of COVID-19 patients exhibit deranged liver function tests.
  • In patients with normal livers, these derangements are generally benign.
  • Severe outcomes like acute decompensation and liver failure occur in patients with chronic liver disease, leading to high mortality.
  • Liver transplant recipients and immunosuppressed autoimmune liver disease patients surprisingly show no increased mortality.

Conclusions:

  • COVID-19 significantly impacts the gastrointestinal tract and liver, primarily through ACE-2 receptor interaction and immune response.
  • While liver derangements can occur, they are often innocuous in healthy individuals but severe in those with underlying liver disease.
  • Immunosuppressed patients, contrary to initial expectations, do not appear to have worse outcomes, warranting further investigation into the underlying mechanisms.

Keywords:
ACLFCirrhosisTransaminitisVaccine

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