COVID-19 and pediatric fatty liver disease: Is there interplay?
Anna Di Sessa1, Francesca Lanzaro2, Sarah Zarrilli2
1Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples 80138, Italy. anna.disessa@libero.it.
Insights
Coronavirus disease 2019 (COVID-19) can cause liver injury, especially in children with fatty liver disease. Metabolic dysfunction exacerbates COVID-19 severity, highlighting the need for monitoring pediatric fatty liver.
Area of Science:
- Hepatology
- Infectious Diseases
- Pediatrics
Background:
- Coronavirus disease 2019 (COVID-19) presents with diverse symptoms, including gastrointestinal and liver manifestations.
- Evidence links COVID-19 to increased liver injury, such as elevated transaminases and hepatic steatosis, particularly in adults.
- Limited but growing evidence suggests similar associations in pediatric populations, with potential implications for disease severity.
Purpose of the Study:
- To review and synthesize current evidence on the relationship between pediatric fatty liver disease and COVID-19.
- To explore the pathogenic mechanisms underlying the interplay between metabolic dysfunction, fatty liver, and COVID-19 severity in children.
- To emphasize the prognostic significance of fatty liver in COVID-19 patients and advocate for vigilant monitoring.
Main Methods:
- Systematic review of recent literature.
- Analysis of epidemiological data and clinical case studies.
- Synthesis of findings on inflammatory pathways and metabolic comorbidities.
Main Results:
- COVID-19 infection is associated with an increased risk of liver injury, including hepatic steatosis.
- Pre-existing chronic liver diseases and metabolic comorbidities heighten the risk of severe COVID-19.
- Pediatric fatty liver disease shares an intrinsic relationship with metabolic abnormalities, influencing COVID-19 prognosis.
Conclusions:
- A strong interplay exists between COVID-19, liver damage, and metabolic health, even in children.
- Monitoring pediatric fatty liver disease is crucial due to its prognostic role in COVID-19.
- Understanding these connections is vital for managing pediatric patients during the COVID-19 pandemic.
Abstract:
The rapid global spread of coronavirus disease 2019 (COVID-19) infection has become a major health issue with higher morbidity and mortality rates. Besides respiratory symptoms, a growing body of evidence indicates a variety of gastrointestinal manifestations including liver involvement. In this regard, several data supported an association between COVID-19 infection and liver injury in adults, while in children there is compelling but currently limited evidence. In particular, patients with COVID-19 have shown a higher risk of liver injury (mainly expressed as increased transaminase levels or hepatic steatosis). Conversely, a greater risk of more severe forms of COVID-19 infection has been observed in subjects with pre-existing chronic liver diseases. The dramatic interplay between COVID-19 and liver damage has been related to the inflammatory pathways chronically active in patients with nonalcoholic fatty liver disease and acutely in those affected by COVID-19, but other different pathogenic mechanisms have also been supposed. Of note, patients with previous metabolic comorbidities also had a higher risk of severe COVID-19 infection. This emphasizes the pathogenic interrelation of the inflammatory pathways with a dysregulated metabolic milieu in COVID-19 patients. Taking into account the prognostic role of fatty liver in COVID-19 patients and its intrinsic relationship with metabolic abnormalities even in childhood, a strict monitoring of this condition is recommended. We aimed to summarize the most recent evidence regarding the potential interplay between pediatric fatty liver and COVID-19.
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