Direct or Collateral Liver Damage in SARS-CoV-2–Infected Patients
María José Lizardo-Thiebaud, Eduardo Cervantes‐Alvarez, Nathaly Limon‐de la Rosa, Farid Tejeda‐Dominguez, Mildred Palacios-Jiménez, Osvely Méndez-Guerrero, Marco Antonio Delaye-Martínez, Fátima Rodríguez-Álvarez, Beatriz Romero-Morales, Weihui Liu, Christene A. Huang, David Kershenobich, Nalu Navarro–Álvarez
Abstract
Liver injury can result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with more than one-third of COVID-19 patients exhibiting elevated liver enzymes. Microvesicular steatosis, inflammation, vascular congestion, and thrombosis in the liver have been described in autopsy samples from COVID-19 patients. Several factors, including direct cytopathic effect of the virus, immune-mediated collateral damage, or an exacerbation of preexisting liver disease may contribute to liver pathology in COVID-19. Due to its immunological functions, the liver is an organ likely to participate in the viral response against SARS-CoV-2 and this may predispose it to injury. A better understanding of the mechanism contributing to liver injury is needed to develop and implement early measures to prevent serious liver damage in patients suffering from COVID-19. This review summarizes current reports of SARS-CoV-2 with an emphasis on how direct infection and subsequent severe inflammatory response may contribute to liver injury in patients with and without preexisting liver disease.