COVID-19 AND THE LIVER

• Pe-existing liver disease is not specifically listed in the published

cohort studies
• Elevated ALT level, reduced paltelet counts, reduced albumin level at
the time of admission have been associated with higher mortality,
although not all of these alterations are independent risk factors
• UNCLEAR:
• sign for pre-existing liver diseases?
• reflect liver damage caused by virus islef?
• mirror a severe inflammatory response (hypoalbuminemia) with DIC
(thrombocytopenia)?
COVID-19 AND THE LIVER
• Increased risk of infection due to cirrhosis-associated immune
dysfunction:
• patients with advanced CLD
• after transplantation
• autoimmune liver disease who receive immunosupressive therapies
• There are only limited data available linking underlying liver diseases
with the course of SARS-COV-2 infection and there are many
questions (Box 1)
COVID-19 AND THE LIVER
• Patients with cirrhosis and cOVID-19 are at increases risk of
decompensation or development of ACLF, as has been shown for
influenza infection.
• SARS-COV-2 may also directly infect liver cells as the receptor of the
virus (ACE2) has been shown to be expressed on cholangiocytes,
which may explain cases of viral shedding into the faeces.
https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(20)30920-X/fulltext
https://www.the-
scientist.com/news-
opinion/receptors-
for-sars-cov-2-
present-in-wide-
variety-of-human-
cells-67496
Liver-related diagnostic procedures for
patients with COVID-19
• Endoscopy :
• limited to emergencies such as GI bleeding, bacterial cholangitis, other life-threatening
conditions
• USG (HCC surveillance)
• should be deferred until after recovery
• Liver biopsy:
• should be deferred in most patients as
• treatment/care for COVID-19 outweighs diagnosis of co-existing liver disease
• systemic inflammation associated with COVID-19 will obscure aetiology-specific histologic
characteristics
• liver biopsy may represent a risk for viral transmission (although the virus has so far not been
detected in liver tissue, the expression of its receptor on cholangiocytes suggests that the virus
might be present in the liver as well).
thank you