Severe acute respiratory syndrome coronavirus 2, the causative pathogen of coronavirus disease 2019 (COVID-19), is highly contagious and has led to a variety of clinical manifestations including liver injury. Although, there have been a few reports indicating acute-on-chronic liver failure among COVID-19 patients, the patients with COVID-19 related liver injury are generally asymptomatic and present with mild to moderate elevation in serum hepatic enzymes. However, severe COVID-19 patients have higher rates of liver injury with worse outcomes. The pattern of abnormalities in liver biochemical indicators can be hepatocellular, cholestatic or mixed. Although the pathogenesis of hepatic injury is incompletely understood, liver injury is proposed to be caused by systemic inflammatory response syndrome, ischemia-reperfusion injury, side effects of medications, and underlying chronic liver diseases. While viral RNA has been detected in hepatocytes, it still remains unknown that the virus has a capacity to cause cytopathic effects in hepatic tissue. Additionally, the current upheaval caused by COVID-19 pandemic has a significant negative effect on delivery of healthcare and outcomes of patients with chronic liver disease.
In this article, we aimed to summarize the current literature on COVID-19 related hepatic injury by addressing clinical features, potential pathogenesis, and histopathological findings of this entity.