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Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients
Asimina Valsamaki1, Maria Xanthoudaki1, Katerina G Oikonomou1
1Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece.
Insights
Severe COVID-19 (Coronavirus disease 2019) can cause significant liver injury, impacting patients with pre-existing liver conditions. Early diagnosis and understanding drug interactions are crucial for managing these critical cases.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, rapidly became a global pandemic.
- Beyond respiratory effects, COVID-19 significantly impacts multiple organs, including the liver.
- Liver injury affects 14.8%-53.0% of severe COVID-19 cases, with characteristic laboratory findings.
Purpose of the Study:
- To review current scientific findings on COVID-19-related liver injury.
- To explore pathophysiological mechanisms and drug- interactions affecting liver function.
- To identify early diagnostic methods for severe liver injury in COVID-19 patients.
Main Methods:
- Literature review of recent scientific findings.
- Analysis of pathophysiological mechanisms of liver injury.
- Examination of drug-liver interactions in COVID-19 treatment.
- Review of diagnostic tests for early detection of liver injury.
Main Results:
- Elevated liver enzymes (AST, ALT, bilirubin) and decreased albumin/prealbumin indicate liver injury.
- Patients with chronic liver disease or cirrhosis face higher risks of severe liver injury.
- The study highlights the impact of COVID-19 on healthcare systems, transplant programs, and patient care.
Conclusions:
- COVID-19 poses a significant threat to liver health, particularly in vulnerable populations.
- Understanding liver injury mechanisms and drug interactions is vital for effective patient management.
- Early diagnostic strategies are essential for improving outcomes in critically ill COVID-19 patients with liver involvement.
Abstract:
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.
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