COVID-19 infection and liver injury: Clinical features, biomarkers, potential mechanisms, treatment, and management challenges

Sivandzadeh, Gholam Reza; Askari, Hassan; Safarpour, Ali Reza; Ejtehadi, Fardad; Raeis-Abdollahi, Ehsan; Vaez Lari, Armaghan; Abazari, Mohammad Foad; Tarkesh, Firoozeh; Bagheri Lankarani, Kamran

It is hypothesized that liver impairment caused by coronavirus disease 2019 (COVID-19) infection might play a central role in severe clinical presentations. Liver injury is closely associated with severe disease and, even with antiviral drugs, have a poor prognosis in COVID-19 patients. In addition to the common hepatobiliary disorders caused by COVID-19, patients with pre-existing liver diseases demand special considerations during the current pandemic. Thus, it is vital that upon clinical presentation, patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure. Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases, particularly in those with pre-existing metabolic liver injury. The purpose of this study was to determine most recent evidence regarding causality, potential risk factors, and challenges, therapeutic options, and management of COVID-19 infection in vulnerable patients with pre-existing liver injury. This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.