Nasir Nosheen, Khanum Iffat, Habib Kiren, Wagley Abdullah, Arshad Aleena, Majeed Atif
Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Research Facilitation Office, Medical College, Aga Khan University, Karachi, Pakistan.
Hepatol Forum. 2024 Jul 2;5(3):139-149. doi: 10.14744/hf.2023.2023.0025. eCollection 2024.
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 injury 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 concurrent 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.
新冠病毒病（COVID-19）已影响全球数百万人，导致了严重的发病率和死亡率。虽然主要累及呼吸道，但严重急性呼吸综合征冠状病毒2（SARS-CoV-2）也引发了涉及其他部位的全身性疾病。观察性研究对COVID-19所致肝损伤的报道不一。据推测，肝损伤可能是由于SARS-CoV-2病毒的直接损伤，或继发于肝毒性治疗方案、细胞因子释放综合征及脓毒症诱导的多器官功能障碍等多种因素。对于合并肝损伤的COVID-19患者，治疗方法需要对肝细胞损伤模式进行全面评估，同时还要考虑是否存在潜在的慢性肝病以及可能导致药物性肝损伤的同时服用的药物。虽然研究表明大多数轻度感染患者可顺利康复，但严重的COVID-19相关肝损伤与更高的死亡率、更长的住院时间以及幸存者更高的发病率相关。此外，由于最近的研究报告其与代谢性脂肪性肝病有关，其对长期预后的影响仍有待确定。本综述通过描述肝损伤的推测机制、其在已有肝病情况下的影响以及其短期和长期的临床意义，为该主题提供了见解。
