Skip to main content
SpringerLink
Log in

COVID-19 Hepatic Illness

  • Chapter
  • First Online:
Critical Care of COVID-19 in the Emergency Department

  • 350 Accesses

Abstract

The hepatic effects of COVID-19 are relatively mild when compared to other organs such as the lungs and heart. Mild transaminase elevations are commonly seen in greater than 50% of patients with moderate to severe disease. Based on current data, it is unclear if patients with preexisting liver disease (NASH/NAFLD) are at higher risk of mortality due to COVID-19. It does appear, however, that those with cirrhosis have an increased risk of severe disease and tend to have a more complicated hospital course. Patients with previous liver transplantation should continue their immunosuppressive medications and see their doctor regularly. Current therapies aimed at the treatment of COVID-19 have been associated with hepatotoxicity including tocilizumab, lopinavir-ritonavir, and remdesivir and require monitoring for such side effects.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Coronavirus Resource Center. Johns Hopkins University & Medicine. Accessed January 2021. https://coronavirus.jhu.edu/.

  2. Argulian E, Sud K, Vogel B, et al. Right ventricular dilation in hospitalized patients with COVID-19 infection. J Am Coll Cardiovasc Imag. 2020;13(11):2459–61.

    Article  Google Scholar 

  3. del Rio C, Malani PN. COVID-19—new insights on a rapidly changing epidemic. JAMA. 2020;323(14):1339–40.

    Article  Google Scholar 

  4. Cao B, Wang Y, Wen D, et al. Atrial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020;382:1787–99.

    Article  Google Scholar 

  5. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18:1559–61.

    Article  CAS  Google Scholar 

  6. Chau TN, Lee KC, Yao H, et al. SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology. 2004;39:302–10.

    Article  Google Scholar 

  7. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020;7(1):11.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. BioRxiv. 2020.

    Google Scholar 

  9. Fan Z, Chen L, Li J, Tian C, Zhang Y, Huang S, et al. Clinical features of COVID-19 related liver damage. medRxiv. 2020.

    Google Scholar 

  10. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of COVID-19 – final report. N Engl J Med. 2020;383:1813–26.

    Article  CAS  Google Scholar 

  11. Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020;5(6):529–30.

    Article  Google Scholar 

  12. Guan W, Ni Z, Liang C, et al. Clinical characteristics of coronavirus disease 2019 in China. NEJM. 2020.

    Google Scholar 

  13. Ji D, Qin E, Xu J, Zhang D, Cheng G, Wang Y. Non-alcoholic fatty liver diseases in patients with COVID-19: a retrospective study. J Hepatol. 2020;73:451–3.

    Article  CAS  Google Scholar 

  14. Qi X, Liu Y, Wang J, et al. For the COVID-Cirrhosis-CHESS Group. Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: a multicentre cohort study. Gut. 2021;70:433–6.

    CAS  PubMed  Google Scholar 

  15. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–9.

    Article  CAS  Google Scholar 

  16. Iavarone M, D’Ambrosio R, Soria A, et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol. 2020;73:1063–71.

    Article  CAS  Google Scholar 

  17. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5:428–30.

    Article  Google Scholar 

  18. Singh S, Khan A. Clinical characteristics and outcomes of coronavirus disease 2019 among patients with preexisting liver disease in the United States: a multicenter research network study. Gastroenterology. 2020;159:768–71.

    Article  CAS  Google Scholar 

  19. AASLD. Clinical insights for hepatology and liver transplant providers during the COVID-19 pandemic. 2020: 1–28.

    Google Scholar 

  20. Wander P, Epstein M, Bernstein D. COVID-19 presenting as acute hepatitis. Am J Gastroenterol. 2020;115(6):941–2.

    Article  Google Scholar 

  21. Sulton S, Altaya O, Siddique SM, et al. AGA institute rapid review of the gastrointestinal and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19. Gastroenterology. 2020;159:320–34.

    Article  Google Scholar 

  22. Centers for Medicare and Medicaid Services. Non-emergent, elective medical services, and treatment recommendations. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf. Accessed Jan 2021.

  23. Cai Q, Huang D, Yu H, et al. COVID-19: abnormal liver function tests. J Hepatol. 2020;73(3):566–74.

    Article  CAS  Google Scholar 

  24. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420–2.

    Article  CAS  Google Scholar 

  25. Jothimani D, Venugopal R, Abdein MF, et al. COVID-19 and the liver. J Hepatol. 2020;73(5):1231–40.

    Article  CAS  Google Scholar 

  26. Tian S, Xiong Y, Liu H, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol. 2020;33(6):1007–14.

    Article  CAS  Google Scholar 

  27. Ando Y, Jou JH. Nonalcoholic fatty liver disease and recent guideline updates. Clin Liver Dis (Hoboken). 2021;17(1):23–8.

    Article  Google Scholar 

  28. Nseir W, Taha H, Khateeb J, et al. Fatty liver is associated with recurrent bacterial infections independent of metabolic syndrome. Dig Dis Sci. 2011;56:3328–34.

    Article  CAS  Google Scholar 

  29. Luo XM, Zhou W, Xia H, Yang W, Yan X, Wang B, Guo T, Ye L, Xiong J, Jiang Z, Liu Y, Zhang B. Characteristics of SARS-CoV-2 infected patients with clinical outcome during epidemic ongoing outbreak in Wuhan, China, SSRN Electron J. 2020.

    Google Scholar 

  30. Bhoori S, Rossi RE, Citterio D, et al. COVID-19 in long term liver transplant patients: preliminary experience from an Italian transplant centre in Lombardy. Lancet Gastroenterol Hepatol. 2020;5(6):532–3.

    Article  Google Scholar 

  31. Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in hospitalized patients with COVID-19 in a New York City Health System. JAMA. 2020;324(8):799–801.

    Article  CAS  Google Scholar 

  32. RECOVERY Collaborative Group. Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2020;396(10259):1345–52.

    Article  Google Scholar 

  33. Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020;369:m1849.

    Article  Google Scholar 

  34. Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of tocilizumab in patients hospitalized with Covid-19. N Engl J Med. 2020;383(24):2333–44.

    Article  CAS  Google Scholar 

  35. Salama C, Han J, Yau L, et al. Tocilizumab in patients hospitalized with Covid-19 pneumonia. N Engl J Med. 2021;384(1):20–30.

    Article  CAS  Google Scholar 

  36. Gupta S, Wang W, Hayek SS, et al. Association between early treatment with tocilizumab and mortality among critically ill patients with COVID-19. JAMA Intern Med. 2021;181(1):41–51.

    Article  CAS  Google Scholar 

  37. Pawar A, Desai RJ, Solomon DH, et al. Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study. Ann Rheum Dis. 2019;78(4):456–64.

    Article  CAS  Google Scholar 

  38. Butt AA, Yan P, Chotani RA, et al. Mortality is not increased in SARS-CoV-2 infected persons with hepatitis C virus infection. Liver Int. 2021. https://doi.org/10.1111/liv.14804. Epub ahead of print

  39. Marjot T, Buescher G, Sebode M, et al. Contributing Members and Collaborators of ERN RARE-LIVER/COVID-Hep/SECURE-Cirrhosis, Moon AM, Webb GJ, Lohse AW. SARS-CoV-2 infection in patients with autoimmune hepatitis. J Hepatol. 2021:S0168-8278(21)00033-7. https://doi.org/10.1016/j.jhep.2021.01.021. Epub ahead of print. PMID: 33508378; PMCID: PMC7835076.

  40. Zheng KI, Gao F, Wang X-B, et al. Letter to the editor: obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease. Metabolism. 2020;108:154244.

    Article  CAS  Google Scholar 

  41. Targher G, Mantovani A, Byrne CD, et al. Risk of severe illness from COVID-19 in patients with metabolic dysfunction-associated fatty liver disease and increased fibrosis scores. Gut. 2020;69:1545–7.

    Article  CAS  Google Scholar 

  42. Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe COVID-19. N Engl J Med. 2020;382:2327–36.

    Article  CAS  Google Scholar 

  43. Albillos A, Lario M, Alvarez-Mon M. Cirrhosis-associated immune dysfunction: Distinctive features and clinical relevance. J Hepatol. 2014;61(6):1385–396.

    Google Scholar 

  44. Sahin T, Akbulut S, Yilmaz S. COVID-19 pandemic: It’s impact on liver disease and liver transplantation. World J Gastroenerol. 2020;26(22):2987–999.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Kimberly Boswell

Authors
  1. Kimberly Boswell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly Boswell .

Editor information

Editors and Affiliations

  1. Departments of Emergency Medicine, Neurology and Surgery, University of Florida Health Science Center, Jacksonville, FL, USA

    Joseph R. Shiber

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Boswell, K. (2021). COVID-19 Hepatic Illness. In: Shiber, J.R. (eds) Critical Care of COVID-19 in the Emergency Department. Springer, Cham. https://doi.org/10.1007/978-3-030-85636-6_12

Download citation

Publish with us

Policies and ethics

Search

Navigation