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COVID-19 and liver dysfunction: Epidemiology, association and potential mechanisms - 27/02/22

Doi : 10.1016/j.clinre.2021.101793 
Min Du a, Song Yang b, Min Liu a, Jue Liu a,
a Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China 
b Center of Hepatology, Beijing Ditan Hospital, Capital Medical University, 8 Jingshun East Street, Chaoyang District, Beijing 100015, China 

Corresponding author.

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Highlights

About 2.0%–4.9% of coronavirus disease 2019 (COVID-19) patients had preexisting liver diseases. The relationship between preexisting liver diseases and adverse outcomes is inconsistent and needs to be explored in a cohort study.
Liver involvement in COVID-19 may affect about 16%–29% of patients. The manifestations of liver injury mainly include elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels.
Most evidence has indicted that liver injury and specific liver biochemical markers are associated with COVID-19 mortality and severity.
The mechanisms are complex and include direct cholangiocyte damage induced by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), cytokine storm, and drug-induced liver injury. Drug-induced liver injury may be the most important reason.

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Abstract

Currently, there have been more than one hundred million confirmed cases of coronavirus disease 2019 (COVID-19), with two million deaths worldwide. This has caused a huge medical burden. Severe COVID-19 patients can experience multi-organ damage, including cardiac injury, kidney injury, and liver injury. About 2.0%–4.9% of COVID-19 cases involve patients with preexisting liver diseases. Additionally, preexisting liver diseases were reported and associated with severity (odds ratio (OR) or risk ratio (RR) = 1.48–1.70) and mortality (OR or RR = 1.08–2.65) among COVID-19 patients. Furthermore, the prevalence of liver injury was 16%–29% in COVID-19 patients. Higher prevalence of liver injury may worsen prognosis in patients (severity: OR or RR = 1.9–2.6; mortality: OR or RR = 1.1–4.0). The mechanisms of this association between liver injury and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection are complex, including direct cholangiocyte damage induced by SARS-COV-2, cytokine storm, and drug-induced liver injury. In particular, drug-induced liver injury may be the most important reason. This review discusses the epidemiology of COVID-19 and liver dysfunction as well as potential mechanisms underlying the association between COVID-19 and liver dysfunction or other preexisting liver diseases. However, the association between preexisting liver diseases and COVID-19 prognosis and potential mechanisms underlying these associations require further prospective studies.

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Keywords : Liver dysfunction, COVID-19, Systematic review


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 COVID-19 and Liver Dysfunction: Epidemiology, Association, and Potential Mechanisms


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Vol 46 - N° 2

Articolo 101793- Febbraio 2022 Ritorno al numero
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