A neglected complication of COVID-19: liver injury

LAN Tian, LIANG Xiaolin,…,GUO Jiao*

[Abstract]Coronavirus disease-2019 (COVID-19) not only causes substantial respiratory pathology, but also results in several extrapulmonary manifestations, including thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologicillnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Recent reports showed about 2%~11% of patients with COVID-19 had underlying chronic liver disease. Here we review the liver-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for liver injury in COVID-19.

[Key words]COVID-19; SARS-CoV-2; Liver injury; Pathophysiology; Therapy

未被重视的新冠病毒感染并发症——肝损伤

[摘要]冠状病毒病-2019 (COVID-19)不仅可引起大量的呼吸病状，还可导致多种肺外表现，包括血栓并发症、心肌功能障碍和心律失常、急性冠状动脉综合征、急性肾损伤、胃肠道症状、肝细胞损伤、高血糖和酮症酸中毒、神经系统疾病、眼部症状和皮肤并发症等。考虑到传染性冠状病毒SARS-CoV-2的进入受体ACE2在多个肺外组织的表达，病毒相关组织直接损伤是一种可能的损伤机制。此外，内皮损伤和血栓形成、免疫反应失调和ace2相关通路适应不良都可能导致COVID-19的这些肺外表现。近期报告显示，约2%~11%的COVID-19患者存在潜在的慢性肝病。在此，我们对COVID-19患者的肝脏特异性病理生理、表现和管理方面进行了综述，以帮助临床医生和科学家识别和监测COVID-19肝脏损伤，并为COVID-19肝损伤制定研究重点和治疗策略。

[关键词]COVID-19;  SARS-CoV-2;  肝损伤;  病理生理学;  治疗