Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease

Li, Jie; Fan, Jian-Gao

Sepsis is not uncommon in severe and critical COVID-19 cases, especially in patients with intestinal microflora imbalance and existing liver cirrhosis. 34 Sepsis is a dysregulated immune response to an infection that leads to psychological stress and multiple organ dysfunction. 35 The pathophysiology of sepsis-related liver injury includes hypoxic liver injury due to ischemia and shock, cholestasis due to altered bile metabolism, hepatocellular injury due to drug toxicity or overwhelming inflammation. 36 Hence, sepsis in COVID-19 patients might be one of the etiologies of liver injury and substantially impairs the prognosis of COVID-19. Furthermore, severe hypoxia and hypovolemia are the major cause of ischemic/hypoxic liver injury in COVID-19 cases with acute lung failure and/or shock. Ischemic/hypoxic liver injury is associated with metabolic acidosis, calcium overloading, and changes of mitochondrial membrane permeability, and has thus far usually manifested as very high aminotransferase concentrations in serum. 37 Drug-induced liver injury or existing liver disease in COVID-19