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COVID-19-induced liver injury in infants, children, and adolescents
Rana Bitar1,2, Ahmed A Elghoudi3,4, David Rawat1,2
1Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Insights
COVID-19 in children often causes mild illness, but liver injury can occur. Pre-existing liver conditions increase the risk of severe COVID-19 outcomes.
Area of Science:
- Pediatrics
- Hepatology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) commonly presents with respiratory symptoms in children, though gastrointestinal and liver manifestations are also observed.
- While most pediatric COVID-19 cases are mild, a subset requires advanced medical care, with liver injury being a notable complication.
Purpose of the Study:
- To review liver manifestations in pediatric COVID-19 patients.
- To detail the epidemiology, mechanisms, clinical presentation, management, and prognosis of liver injury in children with and without pre-existing liver disease, including those with prior liver transplants.
Main Methods:
- This study is a review of existing literature on pediatric COVID-19 and liver manifestations.
- The review synthesizes information on viral invasion, immune responses, and medication effects contributing to liver injury.
Main Results:
- Liver dysfunction in children with COVID-19 can range from mild to severe, influenced by pre-existing liver conditions like non-alcoholic fatty liver disease.
- Liver manifestations are linked to COVID-19 severity and serve as an independent prognostic factor.
- Children with pre-existing liver disease face a higher risk of severe COVID-19 and adverse outcomes.
Conclusions:
- Supportive therapies are crucial for managing COVID-19 in children, with vaccination recommended for high-risk individuals.
- Understanding liver injury mechanisms and prognostic factors is vital for optimizing care and outcomes in pediatric COVID-19 patients.
- The presence of liver disease significantly impacts COVID-19 prognosis in children, necessitating tailored management strategies.
Abstract:
Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms in children. Most children develop an asymptomatic and mild illness, with a minority requiring specialist medical care. Gastrointestinal manifestations and liver injury can also occur in children following infection. The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion, immune response, or medication effects. Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease. However, the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes. On the other hand, the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor. Respiratory, hemodynamic, and nutritional supportive therapies are the mainstay of management. Vaccination of children at increased risk of developing severe COVID-19 disease is indicated. This review describes the liver manifestations in children with COVID-19, detailing its epidemiology, basic mechanisms, clinical expression, management, and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.
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