Liver injury and novel coronavirus infection: development mechanisms and clinical manifestation

Abstract

The novel coronavirus infection (COVID-19) caused by SARS-CoV-2 is characterized by a variety of clinical manifestations. As the infection spreads and the number of observations increases, it is clear that SARS-CoV-2 affects not only the respiratory tract, but also the digestive system. More than half of patients with COVID-19 have changes in the biochemical blood test, indicating liver damage. The reasons for this may be direct cytopathic or mediated immune effect, organ ischemia, the intake of drugs with potential hepatotoxic effects, onset of previously undiagnosed or worsening of the course of an existing liver disease. This article provides a brief overview of the possible etiological factors of liver damage in COVID-19 and presents its own clinical case.

Keywords

novel coronavirus infection / cytolysis syndrome / cholestasis syndrome / autoimmune hepatitis / primary sclerosing cholangitis / drug-induced liver injury / ischemic hepatitis

References

[1] Mao R, Liang J, Shen J, et al. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol. 2020;5(5):425–427. DOI: 10.1016/S2468-1253(20)30076-5

[2] Mao R., Liang J., Shen J. et al. Implications of COVID-19 for patients with pre-existing digestive diseases // Lancet Gastroenterol. Hepatol. 2020. Vol. 5, No. 5. P. 425–427. DOI: 10.1016/S2468-1253(20)30076-5

[3] Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 2020;158(6):1518–1519. DOI: 10.1053/j.gastro.2020.02.054

[4] Gu J., Han B., Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission // Gastroenterology. 2020. Vol. 158, No. 6. P. 1518–1519. DOI: 10.1053/j.gastro.2020.02.054

[5] Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020;73(3):566–574. DOI: 10.1016/j.jhep.2020.04.006

[6] Cai Q., Huang D., Yu H. et al. COVID-19: Abnormal liver function tests // J. Hepatol. 2020. Vol. 73, No. 3. P. 566–574. DOI: 10.1016/j.jhep.2020.04.006

[7] Wu Y, Li H, Guo X, et al. Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis. Hepatol Int. 2020;14(5):621–637. DOI: 10.1007/s12072-020-10074-6

[8] Wu Y., Li H., Guo X. et al. Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis // Hepatol. Int. 2020. Vol. 14, No. 5. P. 621–637. DOI: 10.1007/s12072-020-10074-6

[9] Hunt RH, East JE, Lanas A, et al. COVID-19 and gastrointestinal disease: implications for the gastroenterologist. Dig Dis. 2021;39(2):119–139. DOI: 10.1159/000512152

[10] Hunt R.H., East J.E., Lanas A. et al. COVID-19 and gastrointestinal disease: implications for the gastroenterologist // Dig. Dis. 2021. Vol. 39, No. 2. P. 119–139. DOI: 10.1159/000512152

[11] Zhao Y, Zhao Z, Wang Y, et al. Single-Cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. Am J Respir Crit Care Med. 2020;202(5):756–759. DOI: 10.1164/rccm.202001-0179LE

[12] Zhao Y., Zhao Z., Wang Y. et al. Single-Cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2 // Am. J. Respir. Crit. Care Med. 2020. Vol. 202, No. 5. P. 756–759. DOI: 10.1164/rccm.202001-0179LE

[13] Zhang H, Kang Z, Gong H, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. bioRxiv. 2020. DOI: 10.1101/2020.01.30.927806

[14] Zhang H., Kang Z., Gong H. et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes // bioRxiv. 2020. DOI: 10.1101/2020.01.30.927806

[15] Hu LL, Wang WJ, Zhu QJ, Yang L. Novel coronavirus pneumonia-related liver injury: etiological analysis and treatment strategy. Zhonghua Gan Zang Bing Za Zhi. 2020;28(2):97–99. (In Chinese). DOI: 10.3760/cma.j.issn.1007-3418.2020.02.001

[16] Hu L.L., Wang W.J., Zhu Q.J., Yang L. Novel coronavirus pneumonia-related liver injury: etiological analysis and treatment strategy // Zhonghua Gan Zang Bing Za Zhi. 2020. Vol. 28, No. 2. P. 97–99. (In Chinese). DOI: 10.3760/cma.j.issn.1007-3418.2020.02.001

[17] Liu J, Li S, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763. DOI: 10.1016/j.ebiom.2020.102763

[18] Liu J., Li S., Liu J. et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients // EBioMedicine. 2020. Vol. 55. P. 102763. DOI: 10.1016/j.ebiom.2020.102763

[19] Waseem N, Chen PH. Hypoxic hepatitis: a review and clinical update. J Clin Transl Hepatol. 2016;4(3):263–268. DOI: 10.14218/JCTH.2016.00022

[20] Waseem N., Chen P.H. Hypoxic hepatitis: a review and clinical update // J. Clin. Transl. Hepatol. 2016. Vol. 4, No. 3. P. 263–268. DOI: 10.14218/JCTH.2016.00022

[21] Lightsey JM, Rockey DC. Current concepts in ischemic hepatitis. Curr Opin Gastroenterol. 2017;33(3):158–163. DOI: 10.1097/MOG.0000000000000355

[22] Lightsey J.M., Rockey D.C. Current concepts in ischemic hepatitis // Curr. Opin. Gastroenterol. 2017. Vol. 33, No. 3. P. 158–163. DOI: 10.1097/MOG.0000000000000355

[23] Dunn GD, Hayes P, Breen KJ, Schenker S. The liver in congestive heart failure: a review. Am J Med Sci. 1973;265(3):174–189. DOI: 10.1097/00000441-197303000-00001

[24] Dunn G.D., Hayes P., Breen K.J., Schenker S. The liver in congestive heart failure: a review // Am. J. Med. Sci. 1973. Vol. 265, No. 3. P. 174–189. DOI: 10.1097/00000441-197303000-00001

[25] Rosser BG, Gores GJ. Liver cell necrosis: cellular mechanisms and clinical implications. Gastroenterology. 1995;108(1):252–275. DOI: 10.1016/0016-5085(95)90032-2

[26] Rosser B.G, Gores G.J. Liver cell necrosis: cellular mechanisms and clinical implications // Gastroenterology. 1995. Vol. 108, No. 1. P. 252–275. DOI: 10.1016/0016-5085(95)90032-2

[27] Bertolini A, van de Peppel IP, Bodewes FAJA, et al. Abnormal liver function tests in patients with COVID-19: Relevance and potential pathogenesis. Hepatology. 2020;72(5):1864–1872. DOI: 10.1002/hep.31480

[28] Bertolini A., van de Peppel I.P., Bodewes F.A.J.A. et al. Abnormal liver function tests in patients with COVID-19: Relevance and potential pathogenesis // Hepatology. 2020. Vol. 72, No. 5. P. 1864–1872. DOI: 10.1002/hep.31480

[29] Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–481. DOI: 10.1016/S2213-2600(20)30079-5

[30] Yang X., Yu Y., Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study // Lancet. Respir. Med. 2020. Vol. 8, No. 5. P. 475–481. DOI: 10.1016/S2213-2600(20)30079-5

[31] Genovese MC, Kremer JM, van Vollenhoven RF, et al. Transaminase levels and hepatic events during tocilizumab treatment: pooled analysis of long-term clinical trial safety data in rheumatoid arthritis. Arthritis Rheumatol. 2017;69(9):1751–1761. DOI: 10.1002/art.40176

[32] Genovese M.C., Kremer J.M., van Vollenhoven R.F. et al. Transaminase levels and hepatic events during tocilizumab treatment: pooled analysis of long-term clinical trial safety data in rheumatoid arthritis // Arthritis Rheumatol. 2017. Vol. 69, No. 9. P. 1751–1761. DOI: 10.1002/art.40176

[33] Metawea MI, Yousif WI, Moheb I. COVID 19 and liver: An A-Z literature review. Dig Liver Dis. 2021;53(2):146–152. DOI: 10.1016/j.dld.2020.09.010

[34] Metawea M.I., Yousif W.I., Moheb I. COVID 19 and liver: An A-Z literature review // Dig. Liver Dis. 2021. Vol. 53, No. 2. P. 146–152. DOI: 10.1016/j.dld.2020.09.010

[35] Yang RX, Zheng RD, Fan JG. Etiology and management of liver injury in patients with COVID-19. World J Gastroenterol. 2020;26(32):4753–4762. DOI: 10.3748/wjg.v26.i32.4753

[36] Yang R.X., Zheng R.D., Fan J.G. Etiology and management of liver injury in patients with COVID-19 // World J. Gastroenterol. 2020. Vol. 26, No. 32. P. 4753–4762. DOI: 10.3748/wjg.v26.i32.4753

[37] Livzan MA, Akhmedov VA, Krolevets TS, et al. Informative value of non-invasive markers of liver fibrosis in patients with non-alcoholic fatty liver disease. Ter Arkh. 2016;88(12):62–68. (In Russ.). DOI: 10.17116/terarkh2016881262-68

[38] Ливзан М.А., Ахмедов В.А., Кролевец Т.С. и др. Информативность неинвазивных маркеров фиброза печени у пациентов с неалкогольной жировой болезнью печени // Терапевтический архив. 2016. Т. 88, № 12. С. 62–68. DOI: 10.17116/terarkh2016881262-68

RIGHTS & PERMISSIONS

Livzan M.A., Gaus O.V., Gavrilenko D.A.