Covid-19 and liver complications

COVID-19 is far from over. First reported in November 2019, it still continues to infect millions across the globe globally. As more and more data continue to gather, it has become increasingly clear that COVID-19 is not just a respiratory virus but can impact the normal functioning of other organs as well, including the heart, brain, kidneys, blood vessels, liver and gastrointestinal tract. In this report, we aim to share the latest findings concerning the liver complications associated with COVID 19.

LIVER COMPLICATIONS

Studies carried in China suggests that overall, 2-19% of those infected with COVID-19 had underlying chronic liver disease and about 14-53% of COVID 19 patients develop liver dysfunction, especially those with severe infection. Liver problems in such patients are also associated with poor outcomes.

Liver abnormalities may include high levels of liver enzymes namely, Alanine Transferase (ALT), Aspartate Transferase (AST), alkaline phosphatase (ALP) and bilirubin, indicating temporary liver damage. The levels are higher in severely infected patients as compared to those with mild infections. Studies have shown in critically ill patients, the incidence of hyperbilirubinemia (high bilirubin in the blood) is 1.7 folds higher and hypoalbuminemia (low blood albumin level), another marker of liver injury is increased by 7 times.

A cross-sectional study at an Indian Hospital showed liver injury to be common in COVID 19 infected patients, affecting about 76.9% of the patients in the study group. The study also showed that patients with pre-existing conditions of diabetes and hypertension are at an increased risk of liver injury. Although liver injury in most cases is temporary, in patients with pre-existing liver conditions, such as chronic liver disease, cirrhosis, hepatitis, liver cancer, etc, COVID-19 infection can lead to a higher risk of death as compared to those without pre-existing liver disease.

PATHOPHYSIOLOGY

The COVID 19 infection may cause liver injury in multiple ways. Firstly, the SARS-CoV-2 virus can directly bind to the angiotensin-converting enzyme 2 (ACE2) receptors, found abundantly in the liver cells. This cause direct destruction of the liver cells as it rapidly multiplies in there. The virus can also induce blood clots in the blood vessels supplying the liver and reduce nutrition and oxygen supply to the liver cells. This destroys the liver cells. Studies have also shown that many antivirals prescribed to treat COVID-19 infection might also cause liver injury.

KEEPING THE LIVER SAFE

In patients with pre-existing liver conditions, the best way to avoid complications is to take every precaution to avoid COVID-19 infection. Get vaccinated and follow COVID-19 appropriate behaviour while stepping out. It is also important to eat a healthy diet and exercise regularly to build a good immunity. In those who have recently recovered from the infection, it is important to get your liver tests done as recommended by the doctor to detect liver damage in the early stages. This enables appropriate management and reduced the risk of complications.

-Dr. Rajiv Lochan Lead Consultant - Hpb And Liver Transplantation Surgery, Manipal Hospital Old Airport Road.