Fever and cough are the commonest clinical symptoms of coronavirus disease 2019 (COVID-19), but complications (like pneumonia, respiratory distress syndrome, and multiorgan failure) can affect people with additional comorbidities. COVID-19 may be a newer etiology of the liver disease since liver profile disturbance is one of the most common findings among patients. The molecular mechanism underlying this phenomenon remains still unknown. 

Chen et al in their retrospective case series, including 99 patients with coronavirus disease with none having the histories of hepatic diseases found Hepatobiliary function markers like ALT(Alanine transaminase), AST(Aspartate transaminase), and TIBIL(Total bilirubin) increased in 28%, 35%, and 18% of patients; and Inflammatory markers like CRP(C-reactive protein), ESR(Erythrocyte sedimentation rate), IL-6(Interleukin 6), and LDH(Lactate dehydrogenase) elevated in 86%, 85%, 52%, and 76% of patients ALB(Albumin) and LYM (Lymphocyte) reduced in 98% and 35% cases, respectively. Possible theories of hepatic injury were described for overall disease exacerbation as Damage to T lymphocytes.

Cai et al in their retrospective case series, including 298 patients with coronavirus disease with 2.7% having histories of pre-existing liver disease found severe cases to be associated with underlying diseases. They also found that 14.8% of the subjects experienced liver injury [ALT (max., 59.5 U/L) and AST (max., 65 U/L): 8.7 %, respectively]. Inflammatory markers like CRP (max., 47.13 mg/dL) was found to be increased in 70% cases, IL-6 (max., 28.72 ng/L) increased in 76% of patients. Possible theories of hepatic injury were described for overall disease exacerbation as the inflammatory factor storm 

Yang et al in their retrospective case series, including 52 patients with coronavirus disease found no histories of pre-existing liver disease. 29% were found to have liver dysfunction. Inflammatory markers like ESR (max., 50 mm/h) were found to be increased in 60.9% LYM (min, 0.91_109/L), reduced in 38.3%.

Shi et al in their retrospective case series, including 81 patients with coronavirus disease found hepatitis or liver cirrhosis in 9% of cases. AST (> 40 U/L) was increased in 53% of patients, lowered in asymptomatic patients. Inflammatory markers like LYM (_1.0_109/L) were increased in 67% of the patients.

COVID-19-related liver injury is mostly mild with a hepatocellular pattern. It may impact a substantial proportion of patients, particularly those with a more severe disease course.

SOURCE- Shousha HI, Ramadan A, Lithy R, El-Kassas M. Patterns of liver profile disturbance in patients with COVID-19. World J Clin Cases 2022; 10(7): 2063-2071 [DOI: 10.12998/wjcc.v10.i7.2063]