Quality of evidence: C+
Liver injury during highly pathogenic human coronavirus infections
Authors: Xu L et al.
Journal: Liver International
Objectives: Summarizing the mechanisms underlying hepatic injury during coronaviruses infections (SARS, COVID-19, MERS)
Strength of evidence: Low (summary of the literature, limited by the available literature, not systematic, methodology missing)
Methods/publication type: Review
Highlights :
The COVID19 receptor (ACE2) is abundantly expressed on hepatic endothelial cells
Especially enriched in the bile ducts (as much ACE2 on the bile ducts as in the lungs)
Biopsies show that COVID19 might cause apoptosis of liver cells through bile ducts decay or immunity overactivation
Incidence of liver damage = 14.8% - 53% in patients infected with coronaviruses (ASAT, ALAT, bilirubin disturbed) and up to 78% in non-survivors
Albumin is reduced in severe cases (26.3 - 30.9g / l).
Post mortem biopsies: liver damage caused either by COVID19 or by the treatments
Must closely monitor patients with chronic liver disease (especially hepatitis) and liver-targeting side-effects of the treatments (e.g. macrolides, quinolones, steroids, etc ...)
Favor treatments that impact less the liver and limit inflammation for patients with chronic liver impairment (e.g. ammonium glycyrrhizinate)
Comments