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Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data.

ABSTRACT: The COVID-19 outbreak is a great threat to public health worldwide. Lung injury is the main outcome of COVID-19 infection; however, damage can occur in other organs including the liver. Currently, limited data are available that link underlying liver injury with the severe SARS-CoV-2 infection. This review summarizes the available data on liver test abnormalities in COVID-19 patients; critically evaluates the possible causes of liver injury and provides recommendations for clinicians. In laboratory tests, serum levels of liver test markers notably transaminase, gamma-glutamyl transferase and total bilirubin were significantly higher in severe patients with COVID-19 infection. The use of certain drugs especially lopinavir and ritonavir showed an association with the progression of liver damage in severe cases. Available data suggest that liver injury in COVID-19 patients may result from direct effect by the virus, immune-mediated inflammation or drug-induced toxicity. Some studies demonstrated that COVID-19 patients with pre-existing liver disease are at higher risk for hospitalizations and mortality. Therefore, the impact of pre-existing liver disease on treatment and clinical outcomes of COVID-19 should be determined. Large-scale clinical studies are needed to identify the causes of liver injury in patients with COVID-19 infection.

SUBMITTER: Ali N

PROVIDER: S-EPMC7385135 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data.

Ali Nurshad N

Frontiers in medicine 20200721

The COVID-19 outbreak is a great threat to public health worldwide. Lung injury is the main outcome of COVID-19 infection; however, damage can occur in other organs including the liver. Currently, limited data are available that link underlying liver injury with the severe SARS-CoV-2 infection. This review summarizes the available data on liver test abnormalities in COVID-19 patients; critically evaluates the possible causes of liver injury and provides recommendations for clinicians. In laborat ...[more]

PMID: 32793619

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Project description:BackgroundThe relationship between coronavirus disease 2019 (Covid-19) and ischemic stroke is poorly defined. We aimed to leverage genetic data to investigate reported associations.MethodsGenetic association estimates for liability to Covid-19 and cardiovascular traits were obtained from large-scale consortia. Analyses primarily focused on critical Covid-19, defined as hospitalization with Covid-19 requiring respiratory support or resulting in death. Cross-trait linkage disequilibrium score regression was used to estimate genetic correlations of critical Covid-19 with ischemic stroke, other related cardiovascular outcomes, and risk factors common to both Covid-19 and cardiovascular disease (body mass index, smoking and chronic inflammation, estimated using C-reactive protein). Mendelian randomization analysis was performed to investigate whether liability to critical Covid-19 was associated with increased risk of any of the cardiovascular outcomes for which genetic correlation was identified.ResultsThere was evidence of genetic correlation between critical Covid-19 and ischemic stroke (r g =0.29, FDR p -value=4.65×10 -3 ), body mass index (r g =0.21, FDR- p -value = 6.26×10 -6 ) and C-reactive protein (r g =0.20, FDR- p -value=1.35×10 -4 ), but none of the other considered traits. In Mendelian randomization analysis, liability to critical Covid-19 was associated with increased risk of ischemic stroke (odds ratio [OR] per logOR increase in genetically predicted critical Covid-19 liability 1.03, 95% confidence interval 1.00-1.06, p -value=0.03). Similar estimates were obtained when considering ischemic stroke subtypes. Consistent estimates were also obtained when performing statistical sensitivity analyses more robust to the inclusion of pleiotropic variants, including multivariable Mendelian randomization analyses adjusting for potential genetic confounding through body mass index, smoking and chronic inflammation. There was no evidence to suggest that genetic liability to ischemic stroke increased the risk of critical Covid-19.ConclusionsThese data support that liability to critical Covid-19 is associated with an increased risk of ischemic stroke. The host response predisposing to severe Covid-19 is likely to increase the risk of ischemic stroke, independent of other potentially mitigating risk factors.

Project description:Background The relationship between COVID-19 and ischemic stroke is poorly understood due to potential unmeasured confounding and reverse causation. We aimed to leverage genetic data to triangulate reported associations. Methods and Results Analyses primarily focused on critical COVID-19, defined as hospitalization with COVID-19 requiring respiratory support or resulting in death. Cross-trait linkage disequilibrium score regression was used to estimate genetic correlations of critical COVID-19 with ischemic stroke, other related cardiovascular outcomes, and risk factors common to both COVID-19 and cardiovascular disease (body mass index, smoking and chronic inflammation, estimated using C-reactive protein). Mendelian randomization analysis was performed to investigate whether liability to critical COVID-19 was associated with increased risk of any cardiovascular outcome for which genetic correlation was identified. There was evidence of genetic correlation between critical COVID-19 and ischemic stroke (rg=0.29, false discovery rate [FDR]=0.012), body mass index (rg=0.21, FDR=0.00002), and C-reactive protein (rg=0.20, FDR=0.00035), but no other trait investigated. In Mendelian randomization, liability to critical COVID-19 was associated with increased risk of ischemic stroke (odds ratio [OR] per logOR increase in genetically predicted critical COVID-19 liability 1.03, 95% CI 1.00-1.06, P-value=0.03). Similar estimates were obtained for ischemic stroke subtypes. Consistent estimates were also obtained when performing statistical sensitivity analyses more robust to the inclusion of pleiotropic variants, including multivariable Mendelian randomization analyses adjusting for potential genetic confounding through body mass index, smoking, and chronic inflammation. There was no evidence to suggest that genetic liability to ischemic stroke increased the risk of critical COVID-19. Conclusions These data support that liability to critical COVID-19 is associated with an increased risk of ischemic stroke. The host response predisposing to severe COVID-19 is likely to increase the risk of ischemic stroke, independent of other potentially mitigating risk factors.

Dataset Information

Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data.

Publications

Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data.

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