Hepatic Injury in COVID-19 Patients

Abstract

The practical studies have already proved that  the laboratory liver tests are  highly  useful in the evaluation and treatment of patients with hepatic dysfunction. It has been found that  some of the enzymes and the end products of the metabolic pathway such as serum bilirubin, alanine amino transferase, aspartate amino transferase, ratio of aminotransferases, alkaline phosphatase, gamma glutamyl transferase, 5’ nucleotidase, ceruloplasmin  that  are very sensitive for the abnormality occurred  may be considered as an outstanding  biochemical marker of liver dysfunction. It is noticed that  the novel coronavirus Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) infection mostly leads to respiratory distress syndrome, at the same time  liver injury is also documented. As a matter of fact, the mechanism of liver injury is limited and poorly understood. Therefore, the hepatic injury  might be due to a consequence of systemic inflammatory response, viral infection of hepatocytes, or  it comes as a result of intensive care treatment or drug toxicity. The host angiotensin-converting enzyme 2 (ACE2) receptors, which are widely distributed in type 2 alveolar cells, are the proposed route of viral entrance. It is interesting to note that ACE2 receptors are found in the liver's cholangiocytes, vascular endothelium, and gastrointestinal tract.       

    Histological pictures compatible with vascular alterations are observed, characterized by  the increase in number of portal vein branches associated with lumen massive dilatation, partial or complete luminal thrombosis of portal and sinusoidal vessels, fibrosis of portal tract, focally markedly enlarged and fibrotic.