Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease

Li, Jie; Fan, Jian-Gao

In conclusion, the SARS-CoV-2 infection outbreak has become a global threat to human health over the past 3 months. The COVID-19 disease itself can result in severe and even fatal respiratory diseases, and in mainland China 2.3% of CFR is attributed to ARDS and multiple organ failure. Increasing evidence has demonstrated frequent incident liver injury in COVID-19, especially in patients with multiple organ injury. The liver injury itself has often manifested as transient elevation of serum aminotransferases. However, acute liver failure and obvious intrahepatic cholestasis have been reported in the available studies, but seldomly prevalence of abnormal aminotransferases is significantly higher in severe cases than in mild cases, according to many studies of COVID-19. The underlying mechanisms of liver injury in cases of COVID-19 might include psychological stress, systemic inflammation response, drug toxicity, and progression of preexisting liver diseases, i.e. from simple fatty liver to steatohepatitis. Currently, there is insufficient evidence for SARS-CoV-2 infected hepatocytes or virus-related liver injury in COVID-19 patients, and it is difficult to summarize the role of the immune system in causing liver damage by the virus at present. Therefore, the pathophysiology and implication of liver injury have not yet been fully determined in COVID-19, as reports about liver injury as well as underlying mechanisms are limited.