COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

This detailed summary of the study “COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management” covers various aspects of how COVID-19 affects liver function and the management of liver diseases during the pandemic:

  1. Overview: COVID-19, primarily a respiratory illness, can also lead to extrapulmonary complications like liver injury. The liver injuries range from asymptomatic enzyme elevation to severe dysfunction, especially in patients with severe COVID-19​​​​.
  2. Liver Injury Mechanisms: Liver dysfunction in COVID-19 patients may be due to direct viral damage, drug-induced injury, hypoxia, immune stress, and inflammatory responses. The virus can directly infect liver cells, causing cellular damage. Drug interactions and the side effects of medications used to treat COVID-19 can also contribute to liver injury​​.
  3. Impact on Chronic Liver Disease (CLD) Patients: COVID-19 increases risks for patients with CLD, such as those with alcohol-related liver disease, nonalcoholic fatty liver disease (NAFLD), cirrhosis, and hepatocellular carcinoma (HCC). These patients are more susceptible to severe COVID-19 and increased mortality rates​​.
  4. Liver Transplantation: The pandemic has significantly impacted liver transplantation, with a decrease in the number of transplants and increased risks for candidates. Patients with decompensated cirrhosis face high COVID-19 prevalence and mortality rates​​.
  5. Management Strategies:
    • General Management: Most COVID-19 patients experience mild liver symptoms that resolve without specific therapy. However, those with CLD should have regular liver function tests and receive liver protection drugs​​.
    • Chronic Liver Disease Management: Minimize COVID-19 risks in hospitalized CLD patients, isolate COVID-19 patients from uninfected ones, and use telemedicine when possible. If moderate/severe liver injury develops during COVID-19 treatment, it’s important to identify the cause​​.
    • NAFLD and Viral Hepatitis: Monitor blood glucose and pressure in NAFLD patients. Continue antiviral therapy for HBV/HCV patients and delay initiating treatment if the patient contracts COVID-19​​.
    • Cirrhosis Management: High-risk cirrhosis patients should continue their treatments. Delays in testing for HCC due to the pandemic should be balanced against the risk of delayed diagnosis and treatment​​.

Conclusion: The study emphasizes the importance of understanding and managing liver injury in COVID-19 patients, especially those with preexisting liver conditions. It highlights the need for careful monitoring and adjustment of treatments to mitigate the risks of liver injury and optimize patient outcomes during the pandemic.

Read More: https://www.sciencedirect.com/science/article/pii/S075333222200957X

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