Liver Injury and Dysfunction Associated with COVID-19: a Review Article

The coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on health, the economy, and social life throughout the world. COVID-19 pathology mainly involves the lungs. However, other organs can also be involved, including the liver, resulting in liver injury, elevated liver enzymes and reduced albumin levels. Involvement of the liver may increase the possibility of a misdiagnosis due to atypical presentations. This re-view article aimed to highlight the impact of COVID-19 on the liver, focusing on liver injury and its effect on severity and prognosis.

The author reviewed all published and in-press articles about COVID-19-associated liver injury using four electronic databases. A total of 55 articles were included in this review after removing duplicate records and establishing the necessary relevance. This review summarizes the recent studies focusing on how SARS-CoV-2 infection affects liver histology, liver enzymes, and albumin levels.

COVID-19 is associated with varying degrees of liver injury, most notably increased levels of aspartate transaminase and alanine transaminase. Patients with severe COVID-19 are more likely to develop liver injury, elevation in the liver enzymes, and reduction in the albumin levels. In addition, COVID-19 patients with pre-existing liver injury are predisposed to develop more severe disease and have a poorer prognosis and higher mortality. Portal inflammation and focal hepatic necrosis are the most common histopathological characteristics observed among COVID-19-associated liver injury patients. The mechanisms of liver injury in COVID-19 are thought to arise from systemic inflammatory responses, hypoxia-reperfusion dysfunction, drug-induced liver injury, and/or a direct effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Clinicians need to be alert when dealing with COVID-19 patients who have chronic liver disease, particularly when prescribing medications to avoid the risk of drug-induced liver injury. Monitoring liver enzymes and albumin levels during COVD-19 illness is essential, as it predicts disease severity and prognosis.