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Liver Update: Hepatic manifestations and complications of COVID-19: A systematic review and meta-analysis

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eMediNexus    29 July 2021

 

Emerging data suggest the possible role of COVID-19 in worsening hepatic manifestations such as acute hepatic injury. Wang et al, in their recently published study, reported 28.7% of patients developed liver enzyme abnormalities.  

The analysis included nineteen retrospective cohort studies comprising 15,103 patients with COVID-19. Among 19, fourteen studies were based in China and five in the USA. 

Subgroup analyses suggested the incidence of acute hepatic injury to be-

  • Higher in Chinese populations
  • Higher in groups with a higher prevalence of pre-existing chronic liver disease
  • Similar in older (≥ 60 years) or younger age (< 60 years) groups.

The common hepatic complications of COVID-19 are- 

  • Liver enzyme abnormalities (particularly the aminotransferases) > acute hepatic injury > hypoproteinaemia. 
  • Common hepatic manifestations on admission are-
  • Elevated levels of ALT, AST and total bilirubin 
  • Low albumin levels. 

The causes of liver injury in COVID-19 was explained by the following mechanistic pathways-

  • Drug-induced while treatment; 
  • Direct injury to the liver because of COVID-19 hepatitis; 
  • COVID-19 induced myositis causing an increase in circulating levels of liver enzymes; 
  • Binding of SARS CoV-2 directly to angiotensin-converting enzyme 2 (ACE2) positive rich cholangiocytes and causing liver damage; 
  • Hepatic congestion due to high levels of positive end-expiratory pressure during mechanical ventilation; and increased liver injury by SARS CoV-2 in patients with pre-existing viral hepatitis

This suggests a positive correlation between a higher prevalence of pre-existing chronic liver disease and a higher incidence of acute hepatic injury.

Thus intensive monitoring of markers of these complications and management during admission could help favorable outcomes. 

Source: J Infect. 2020;81(3):e72-e74. doi:10.1016/j.jinf.2020.06.043

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