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Insight into COVID-19 associated liver injury: Mechanisms, evaluation, and clinical implications
1Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
2Research Facilitation Office, Medical College, Aga Khan University, Karachi, Pakistan
3Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
Hepatology Forum 2024; 5(3): 139-149 DOI: 10.14744/hf.2023.2023.0025 PMCID: PMC11237249
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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 in-jury 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 the 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 the pattern of hepatocellular injury, along with the presence of underlying chronic liver disease and concur-rent 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 an 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.