Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease

Li, Jie; Fan, Jian-Gao

Under physiological conditions, the liver is the important organ that meets and filters a large amount of alien material, and then maintains immune tolerance through gut-liver axis. However, immune tolerance is interrupted under psychological stress conditions in patients with severe COVID-19. Hyperactivated immune responses and cytokine stormrelated systemic inflammation in SARS-CoV-2 infection can affect and damage many organs, including the gut and liver. Peripheral blood levels of Th17 and CD8 T cells, interleukin-2, interleukin-6, interleukin-7, interleukin-10, tumor necrosis factor-a, granulocyte-colony stimulating factor, interferoninducible protein-10, monocyte chemotactic protein 1, macrophage inflammatory protein 1 alpha in severe patients were significantly higher than those in control patients. 18, 21, 22, 32, 33 In the same way, abnormal liver biochemistries have also occurred often in severe COVID-19 cases. Stress-induced liver injury might be associated with hypoxia-reoxygenation, over-activation of Kupffer cells and oxidative stress, intestinal endotoxemia, and activation of the sympathetic nervous and adrenocortical system in COVID-19 patients.