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Insight into COVID-19 associated liver injury: Mechanisms, evaluation, and clinical implications
1Department of Adult Infectious Diseases, Faculty of Medicine, Aga Khan University, Karachi, Pakistan
2Research Facilitation Office, Medical College, Aga Khan University, Karachi, Pakistan
3Department of Gastroenterology, Faculty of Medicine, Aga Khan University, Karachi, Pakistan
Hepatology Forum - DOI: 10.14744/hf.2023.2023.0025
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Abstract

COVID-19 has affected millions worldwide, causing significant morbidity and mortality. While predominantly involving the respiratory tract, SARS-CoV-2 has also caused systemic illnesses involving other sites. Liver injury due to COVID-19 has been variably reported in observational studies. It has been postulated that liver damage may be due to direct damage by SARS-CoV-2 virus or multifactorial secondary to hepatotoxic therapeutic options as well as cytokine release syndrome and sepsis-induced multiorgan dysfunction. The approach to a COVID-19 patient with liver injury requires a thorough evaluation of pattern of hepatocellular injury along with presence of underlying chronic liver disease and concurrent medications which may cause drug induced liver injury. While studies have shown uneventful recovery in the majority of mildly affected patients; severe COVID-19 associated liver injury has been associated with higher mortality, prolonged hospitalization, and greater morbidity in survivors. Furthermore, its impact on long term outcomes remains to be ascertained as recent studies report association with metabolic-fatty liver disease. This present review provides insight into the subject by describing the postulated mechanism of liver injury, its impact in the presence of pre-existing liver disease and its short- and long-term clinical implications.