Review
BibTex RIS Cite

SARS-CoV-2 Infection and Liver Involvement

Year 2022, Volume: 6 Issue: 1, 1 - 7, 30.04.2022
https://doi.org/10.34084/bshr.989891

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, single-stranded RNA virus that can also be transmitted from person to person via the droplet (secretions shed when speaking, sneezing, or coughing) route, suspended droplet nuclei, and the mucous membranes of the eyes, nose, and mouth after touching a contaminated surface. It enters the cells through the angiotensin converting enzyme 2 (ACE- 2) receptor. Although non-specific respiratory symptoms such as fever, loss of smell/taste, runny nose, and cough are most common, SARS-CoV-2 can lead to a systemic and multiorgan involvement, including the gastrointestinal tract. The liver is the second most frequently involved organ after the lung. Gastrointestinal symptoms such as diarrhea, anorexia, nausea, vomiting, loss of appetite and abdominal pain are also common. Abnormal liver function enzyme levels may also be observed. The liver is affected by direct infection of hepatocytes, medical therapy of the management, or by indirect means if there is an underlying co-morbid disease. However, there are significant differences between studies in the reporting of gastrointestinal and liver symptoms. The most frequently reported gastrointestinal symptom in COVID-19 disease is diarrhea, reported in 1-36% of patients. In this review, it is aimed to review the current data on the effects of COVID-19 on the liver.

References

  • WHO Coronavirus (COVID-19) Dashboard, Situation by Region, Country, Territory & Area https://covid19.who.int/table
  • Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052
  • Xu H, Zhong L, Deng J, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020; 12(1):8. doi: 10.1038/s41368-020-0074-x.
  • Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 382(18):1708-1720. doi: 10.1056/NEJMoa2002032.
  • Centers for Disease Control and Prevention (2020). People who are at higher risk for severe illness https://www.cdc.gov/coronavirus/2019-ncov/need-extraprecautions/people-at-higherrisk.html (Accessed on April 01, 2020).
  • Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20(6):689-696. doi: 10.1016/S1473-3099(20)30198-5.
  • Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382(10);970-1. https://doi.org/10.1056/nejmc2001468.
  • Li D, Wang D, Dong J, et al. False-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2: Role of deep-learning-based ct diagnosis and insights from two cases. Korean J Radiol. 2020;21(4):505-8. doi: 10.3348/kjr.2020.0146.
  • Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn. 2020; 20(5):453-4. https://doi.org/10.1080/14737159.2020.1757437
  • WHO. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. Interim guidance 1-7, World Health Organization. [https://apps.who.int/iris/handle/10665/331501] (Accessed on 19/01/2021).
  • Hung IF, Cheng VC, Wu AK, et al. Viral loads in clinical specimens and SARS manifestations. Emerg. Infect. Dis. 2004; 10(9):1550-7. doi: 10.3201/eid1009.040058.
  • Zhang C, Shi L, Wang FS. Liver injury in COVID‐19: management and challenges. Lancet Gastroenterol. Hepatol. 20205(5):428-430. doi: 10.1016/S2468-1253(20)30057-1.
  • Leung WK, To KF, Chan PK, et al. Enteric involvement of severe acute respiratory syndrome‐associated coronavirus infection. Gastroenterology 2003; 125(4):1011-7. doi: 10.1016/s0016-5085(03)01215-0.
  • Zhou J, Li C, Zhao G, et al. Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirus. Sci. Adv. 2017; 3(11):eaao4966. doi: 10.1126/sciadv.aao4966.
  • Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929-936. doi: 10.1056/NEJMoa2001191.
  • Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020 28; 395(10229): 1054–1062. doi: 10.1016/S0140-6736(20)30566-3.
  • García de Guadiana-Romualdo L, Morell-García D, Morales-Indiano C, et al. Characteristics and laboratory findings on admission to the emergency department among 2873 hospitalized patients with COVID‐19: the impact of adjusted laboratory tests in multicenter studies. A multicenter study in Spain (BIOCOVID‐Spain study). Scand J Clin Lab Invest. 2021; 81(3):187-193. doi: 10.1080/00365513.2021.1881997.
  • Pourbagheri‐Sigaroodi A, Bashash D, Fateh F, et al. Laboratory findings in COVID‐19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475–82. doi: 10.1016/j.cca.2020.08.019.
  • Doğan Ö, Devrim E. Tanı ve İzlemde Laboratuvar Testleri. COVID‐19 içinde Ed: Memikoğlu O, Genç V. E‐Kitap Ankara Üniversitesi Basımevi, 2020; 35‐40
  • Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Engl J Med. 2020;382(8):727-733. doi: 10.1056/NEJMoa2001017.
  • Hoffmann M, Kleine‐Weber H, Schroeder S, et al. SARS‐CoV‐2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181(2):271-280.e8. doi: 10.1016/j.cell.2020.02.052.
  • Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395(10224):565-574. doi: 10.1016/S0140-6736(20)30251-8.
  • Walls AC, Park YJ, Tortorici MA, et al. Structure, function, and antigenicity of the SARS‐CoV‐2 spike glycoprotein. Cell 2020; 181(2):281-292.e6. doi: 10.1016/j.cell.2020.02.058
  • Zhou YH, Zheng KI, Targher G, et al. Abnormal liver enzymes in children and infants with COVID-19: A narrative review of case-series studies. Pediatr Obes. 2020; 15(12): e12723. doi: 10.1111/ijpo.12723.
  • Tian Y, Rong L, Nian W, et al. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020; 51(9): 843-851. doi: 10.1111/apt.15731.
  • Xu L, Liu J, Lu M, et al. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998-1004. doi: 10.1111/liv.14435.
  • Zeng-hong W. Dong liang Y. A meta-analysis of the impact of COVID-19 on liver dysfunction. Eur J Med Res. 2020;25(1):54. doi: 10.1186/s40001-020-00454-x.
  • Olry A, Meunier L, Délire B, et al. Drug Induced Liver Injury and COVID 19 Infection: The Rules Remain the Same. Drug Saf. 2020; 43(7):615-617. doi: 10.1007/s40264-020-00954-z.
  • Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respir Med. 2020;8(4)420-422. doi: 10.1016/S2213-2600(20)30076-X.
  • Tian SF, Xiong Y, Liu H, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through post-mortem core biopsies. Modern Pathology. 2020; 33(6):1007-1014. doi: 10.1038/s41379-020-0536-x.
  • Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223): 507-513. doi: 10.1016/S0140-6736(20)30211-7.
  • Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020. 382(18):1708-1720. doi: 10.1056/NEJMoa2002032 .
  • Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS‐CoV‐2 pneumonia in Wuhan, China: a single‐centered, retrospective, observational study. Lancet Respir. Med. 2020; 8(5):475-481. doi: 10.1016/S2213-2600(20)30079-5.
  • Schaefer EAK, Arvind A, Chung RT, et al. Interrelationship Between Coronavirus Infection and Liver Disease. Clinical Liver Disease 2020; 15(5):175-180. doi: 10.1002/cld.967.
  • Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019‐nCoV infected patients: implication of multiple shedding routes. Emerg. Microbes. Infect. 2020; 9: 386- 389. doi: 10.1080/22221751.2020.1729071.
  • Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS‐CoV‐2 infection and potential evidence for persistent fecal viral shedding. Nat. Med. 2020. 26(4):502-505. doi: 10.1038/s41591-020-0817-4.
  • Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol 2020; 5: 529-530. doi: 10.1016/S2468-1253(20)30084-4.
  • Wu J, Song S, Cao HC, Li LJ. Liver diseases in COVID-19: Etiology, treatment and prognosis. World J Gastroenterol 2020; 26: 2286-2293. doi: 10.3748/wjg.v26.i19.2286.
  • Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019‐nCoV pneumonia. Transl Pediatr. 2020;9:51‐60. doi: 10.21037/tp.2020.02.06.
  • American Association for the Study of Liver Diseases . Clinical insights for hepatology and liver transplant providers during the COVID‐19 pandemic. https://www.aasld.org/about-aasld/covid19-resources. Accessed April 14, 2020.

SARS-CoV-2 Enfeksiyonu ve Karaciğer tutulumu

Year 2022, Volume: 6 Issue: 1, 1 - 7, 30.04.2022
https://doi.org/10.34084/bshr.989891

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) insandan insana damlacık yolu (konuşurken, hapşırırken veya öksürürken saçılan sekresyonlar vb.), asılı damlacık çekirdekleri ve kontamine yüzeylere dokunma sonrası gözler, burun ve ağız mukozası ile temas sonrası bulaşabilen zarflı, tek zincirli bir RNA virüsüdür. Hücrelere anjiotensin converting enzim 2 (ACE- 2) reseptör aracılığı ile girmektedir. En sık ateş, koku/tat kaybı, burun akıntısı ve öksürük gibi non-spesifik solunum yolu semptomları görülse de SARS-CoV-2 enfeksiyonu gastrointestinal sistemi de içeren sistemik ve çoklu organ tutulumu ile giden bir tabloya yol açabilir. Karaciğer, akciğerden sonra ikinci sık tutulan organdır. İshal, anoreksi, mide bulantısı, kusma, iştah kaybı ve karın ağrısı gibi gastrointestinal semptomlar da sık görülmektedir. Anormal karaciğer fonksiyon enzim düzeyleri de gözlenebilir. Karaciğer hepatositlerin direk enfekte olmasıyla, tedavide kullanılan ilaçlar üzerinden ya da altta yatan bir ko-morbid hastalık varsa indirek yollar ile etkilenir. Bununla beraber, gastrointestinal ve karaciğer semptomlarının bildirilmesinde, çalışmalar arasında ciddi farklılıklar söz konusudur. COVID-19 hastalığında da en sık bildirilen gastrointestinal semptom ishal olup, hastaların %1-36'sında bildirilmiştir. Bu derlemede COVID-19 hastalığının karaciğer üzerindeki etkilerine ilişkin güncel verilerin gözden geçirilmesi amaçlanmıştır.

References

  • WHO Coronavirus (COVID-19) Dashboard, Situation by Region, Country, Territory & Area https://covid19.who.int/table
  • Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052
  • Xu H, Zhong L, Deng J, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020; 12(1):8. doi: 10.1038/s41368-020-0074-x.
  • Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 382(18):1708-1720. doi: 10.1056/NEJMoa2002032.
  • Centers for Disease Control and Prevention (2020). People who are at higher risk for severe illness https://www.cdc.gov/coronavirus/2019-ncov/need-extraprecautions/people-at-higherrisk.html (Accessed on April 01, 2020).
  • Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20(6):689-696. doi: 10.1016/S1473-3099(20)30198-5.
  • Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382(10);970-1. https://doi.org/10.1056/nejmc2001468.
  • Li D, Wang D, Dong J, et al. False-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2: Role of deep-learning-based ct diagnosis and insights from two cases. Korean J Radiol. 2020;21(4):505-8. doi: 10.3348/kjr.2020.0146.
  • Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn. 2020; 20(5):453-4. https://doi.org/10.1080/14737159.2020.1757437
  • WHO. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. Interim guidance 1-7, World Health Organization. [https://apps.who.int/iris/handle/10665/331501] (Accessed on 19/01/2021).
  • Hung IF, Cheng VC, Wu AK, et al. Viral loads in clinical specimens and SARS manifestations. Emerg. Infect. Dis. 2004; 10(9):1550-7. doi: 10.3201/eid1009.040058.
  • Zhang C, Shi L, Wang FS. Liver injury in COVID‐19: management and challenges. Lancet Gastroenterol. Hepatol. 20205(5):428-430. doi: 10.1016/S2468-1253(20)30057-1.
  • Leung WK, To KF, Chan PK, et al. Enteric involvement of severe acute respiratory syndrome‐associated coronavirus infection. Gastroenterology 2003; 125(4):1011-7. doi: 10.1016/s0016-5085(03)01215-0.
  • Zhou J, Li C, Zhao G, et al. Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirus. Sci. Adv. 2017; 3(11):eaao4966. doi: 10.1126/sciadv.aao4966.
  • Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929-936. doi: 10.1056/NEJMoa2001191.
  • Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020 28; 395(10229): 1054–1062. doi: 10.1016/S0140-6736(20)30566-3.
  • García de Guadiana-Romualdo L, Morell-García D, Morales-Indiano C, et al. Characteristics and laboratory findings on admission to the emergency department among 2873 hospitalized patients with COVID‐19: the impact of adjusted laboratory tests in multicenter studies. A multicenter study in Spain (BIOCOVID‐Spain study). Scand J Clin Lab Invest. 2021; 81(3):187-193. doi: 10.1080/00365513.2021.1881997.
  • Pourbagheri‐Sigaroodi A, Bashash D, Fateh F, et al. Laboratory findings in COVID‐19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475–82. doi: 10.1016/j.cca.2020.08.019.
  • Doğan Ö, Devrim E. Tanı ve İzlemde Laboratuvar Testleri. COVID‐19 içinde Ed: Memikoğlu O, Genç V. E‐Kitap Ankara Üniversitesi Basımevi, 2020; 35‐40
  • Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Engl J Med. 2020;382(8):727-733. doi: 10.1056/NEJMoa2001017.
  • Hoffmann M, Kleine‐Weber H, Schroeder S, et al. SARS‐CoV‐2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181(2):271-280.e8. doi: 10.1016/j.cell.2020.02.052.
  • Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395(10224):565-574. doi: 10.1016/S0140-6736(20)30251-8.
  • Walls AC, Park YJ, Tortorici MA, et al. Structure, function, and antigenicity of the SARS‐CoV‐2 spike glycoprotein. Cell 2020; 181(2):281-292.e6. doi: 10.1016/j.cell.2020.02.058
  • Zhou YH, Zheng KI, Targher G, et al. Abnormal liver enzymes in children and infants with COVID-19: A narrative review of case-series studies. Pediatr Obes. 2020; 15(12): e12723. doi: 10.1111/ijpo.12723.
  • Tian Y, Rong L, Nian W, et al. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020; 51(9): 843-851. doi: 10.1111/apt.15731.
  • Xu L, Liu J, Lu M, et al. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998-1004. doi: 10.1111/liv.14435.
  • Zeng-hong W. Dong liang Y. A meta-analysis of the impact of COVID-19 on liver dysfunction. Eur J Med Res. 2020;25(1):54. doi: 10.1186/s40001-020-00454-x.
  • Olry A, Meunier L, Délire B, et al. Drug Induced Liver Injury and COVID 19 Infection: The Rules Remain the Same. Drug Saf. 2020; 43(7):615-617. doi: 10.1007/s40264-020-00954-z.
  • Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respir Med. 2020;8(4)420-422. doi: 10.1016/S2213-2600(20)30076-X.
  • Tian SF, Xiong Y, Liu H, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through post-mortem core biopsies. Modern Pathology. 2020; 33(6):1007-1014. doi: 10.1038/s41379-020-0536-x.
  • Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223): 507-513. doi: 10.1016/S0140-6736(20)30211-7.
  • Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020. 382(18):1708-1720. doi: 10.1056/NEJMoa2002032 .
  • Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS‐CoV‐2 pneumonia in Wuhan, China: a single‐centered, retrospective, observational study. Lancet Respir. Med. 2020; 8(5):475-481. doi: 10.1016/S2213-2600(20)30079-5.
  • Schaefer EAK, Arvind A, Chung RT, et al. Interrelationship Between Coronavirus Infection and Liver Disease. Clinical Liver Disease 2020; 15(5):175-180. doi: 10.1002/cld.967.
  • Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019‐nCoV infected patients: implication of multiple shedding routes. Emerg. Microbes. Infect. 2020; 9: 386- 389. doi: 10.1080/22221751.2020.1729071.
  • Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS‐CoV‐2 infection and potential evidence for persistent fecal viral shedding. Nat. Med. 2020. 26(4):502-505. doi: 10.1038/s41591-020-0817-4.
  • Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol 2020; 5: 529-530. doi: 10.1016/S2468-1253(20)30084-4.
  • Wu J, Song S, Cao HC, Li LJ. Liver diseases in COVID-19: Etiology, treatment and prognosis. World J Gastroenterol 2020; 26: 2286-2293. doi: 10.3748/wjg.v26.i19.2286.
  • Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019‐nCoV pneumonia. Transl Pediatr. 2020;9:51‐60. doi: 10.21037/tp.2020.02.06.
  • American Association for the Study of Liver Diseases . Clinical insights for hepatology and liver transplant providers during the COVID‐19 pandemic. https://www.aasld.org/about-aasld/covid19-resources. Accessed April 14, 2020.
There are 40 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Review
Authors

Mehmet Çoban 0000-0003-3611-3501

Dilşat Gündoğdu Çoban 0000-0002-6845-7432

Öner Özdemir 0000-0002-5338-9561

Publication Date April 30, 2022
Acceptance Date January 6, 2022
Published in Issue Year 2022 Volume: 6 Issue: 1

Cite

AMA Çoban M, Gündoğdu Çoban D, Özdemir Ö. SARS-CoV-2 Infection and Liver Involvement. J Biotechnol and Strategic Health Res. April 2022;6(1):1-7. doi:10.34084/bshr.989891

Journal of Biotechnology and Strategic Health Research