COVID-19-associated liver injury: from bedside to bench

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a global challenge since December 2019. Although most patients with COVID-19 exhibit mild clinical manifestations, in approximately 5% of these patients, the disease eventually progresses to severe lung injury or even multiorgan dysfunction. This situation represents various challenges to hepatology. In the context of liver injury in patients with COVID-19, several key problems need to be solved. For instance, it is important to determine whether SARS-CoV-2 can directly invade liver, especially when ACE2 appears to be negligibly expressed on hepatocytes. In addition, the mechanisms underlying liver dysfunction in COVID-19 patients are not fully understood, which are likely multifactorial and related to hyperinflammation, dysregulated immune responses, abnormal coagulation and drugs. Here, we systematically describe the potential pathogenesis of COVID-19-associated liver injury and propose several hypotheses about its etiopathogenesis.

Automated summary

The COVID-19 outbreak has posed a global challenge since December 2019, with approximately 5% of patients progressing to severe lung injury or multiorgan dysfunction. The mechanisms underlying liver dysfunction in COVID-19 patients are not fully understood and may be multifactorial, related to inflammation, immune responses, coagulation, and drugs. Further research is needed to explore these relationships.