The Effects of COVID-19 on Liver Disease

Introduction:

COVID-19 is a serious infectious disease that spreads easily from one person to another person. It is caused by the virus SARS-CoV-2 (severe acute respiratory syndrome), which belongs to a family of coronavirus. It causes mild symptoms like fever, throat pain, diarrhea, cough, tiredness, headache, and loss of sense of taste and smell. Severe symptoms like breathing difficulty, confusion, unable to move, and chest pain are also seen. It causes severe health risks in patients with liver disease. The COVID-19 infection damages the liver, increasing the levels of liver enzymes like alanine aminotransferase (ALT) and aspartate aminotransferase (AST). This results in temporary damage to the liver in healthy individuals.

The COVID-19 infection causes serious damage to the liver in patients with an underlying liver disease like liver cancer or cirrhosis (scarring of liver cells). The liver has a self-healing property; thus, in mild to moderate cases, the liver repairs over time. Though the liver heals over time, in severe liver damage with underlying liver disease, the damage is irreversible.

What Is COVID-19 Infection?

Coronavirus (CoV) is present in many species like humans, pigs, mice, and other species. COVID-19 is a coronavirus infection that was found in 2019 in China. Hence it is named COVID-19. COVID-19 infection spreads fast from one person to another person by touching infection-exposed areas and placing hands over the mouth, ears, nose, or eyes. It is caused by SARS-CoV-2 (severe acute respiratory syndrome associated with coronavirus). It affects people of all ages. Some people infected with COVID-19 infection show no symptoms, and some show mild symptoms. Some people have severe symptoms and complications. The reason for the difference in the severity of the disease is unknown. People with underlying diseases or conditions are prone to complications.

What Are the Symptoms of COVID-19 Infection?

• Sore throat.

• Throat pain.

• Fever.

• Diarrhea.

• Headache.

• Loss of taste and smell.

• Body pain.

• Breathing difficulty.

• Chest pain.

• Confusion.

• Inability to move.

How does COVID-19 Infection Affect the Liver?

It is unclear whether the COVID-19 virus infects and multiplies within the liver and causes damage to the tissues. Some factors mentioned below contribute to the COVID-19 infection in the liver:

• Systemic Inflammatory Response Syndrome: The body system's vigorous defense response to an infection or noninfectious attack on the body to remove the source of infection. This results in a series of reactions that damages the body's tissues.

• Cytokine Storm: Cytokine is a protein that is made by immune and non-immune cells. It plays an important role in the immune system. The cytokine can boost and slow down the immune system. Cytokine storm is a life-threatening immune response state where too many cytokines are released into the blood at a fast rate. Though cytokines play an important role in normal immune reactions, too many cytokines in the blood can cause harmful effects like organ failure.

• Ischemic Reperfusion Injury: It is the worsening of cellular dysfunction and death of the cells. This results when the blood supply to the site where there is low blood flow or oxygen supply is restored. This causes damage to the tissues.

• Direct Liver Injury: Angiotensin-converting enzyme 2 acts as a receptor for coronavirus 2. It provides entry into the organ directly. The angiotensin-converting-enzyme is an enzyme that is within the renin-angiotensin system (RAS). RAS regulates blood pressure and fluid balance. The angiotensin-converting-enzyme is present in all cells.

• Drug-Induced Liver Injury: Medications administered can cause damage to the liver cells.

What Happens to Liver After COVID-19 Infection?

It causes temporary damage to the liver cells, causing an increase in the levels of certain liver enzymes like alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transferase (GGT), and bilirubin. Abnormal values of AST are more common than other liver enzymes. Elevated levels of AST and GGT are more common in patients with underlying liver diseases like non-alcoholic fatty liver disease.

What Happens in COVID-19 With Liver Disease?

In patients with liver diseases like cirrhosis, liver cancer, viral hepatitis, and liver transplant patients, the COVID-19 infection causes severe liver damage. In patients with liver diseases like cirrhosis, non-alcoholic fatty liver, non-alcoholic steatosis, alcoholic hepatitis, and liver cancer, the disease condition worsens and causes death in most cases. In patients with liver cirrhosis, the mortality (death) rate is high.

How Is Liver Disease Diagnosed in COVID-19 Infection?

• Liver Function Tests (LFT): Liver function tests are a group of tests performed to rule out liver disease. Liver enzymes like alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LD) are checked. Proteins like albumin and globulin, bilirubin, and prothrombin tests are done. Elevated levels of AST, GGT, and ALT are expected in COVID-19 infection in liver disease patients.

How Are COVID-19 Patients With Liver Injury Treated?

The treatment depends on the nature of the underlying disease and general management protocols usually followed for COVID-19 infection.

• Paracetamol.

• Multivitamins like Vitamin C and Zinc.

• Hospitalization and close monitoring of the patient.

• Ventilation in severe cases.

• No antiviral drugs for patients with cirrhosis.

What Are the Complications of COVID-19 Infection in Liver Disease?

• Worsening of the pre-existing liver disease.

• Hospitalization.

• Ventilation is required in most cases.

• Death in severe liver damage with underlying liver disease.

What Is the Prognosis of COVID-19 Infection With Liver Disease?

The prognosis is poor for COVID-19 patients with liver disease.

How to Prevent COVID-19 Infection?

• Get vaccinated.

• Wearing a triple-layer mask.

• Do not touch eyes, nose, ears, and mouth without washing hands with soap and water.

• Wash hands after entering the house and before meals.

• Maintain a six-feet distance when you are in a social gathering.

• Frequently wash hands or sanitize if you are outside your house.

• Disinfect the doorknob, door, and entrance of your house frequently.

• Disinfect the purchased grocery store items.

Conclusion:

COVID-19 viral infection is a life-threatening pandemic disease. Though this is life-threatening, few patients with COVID-19 infection had mild or no symptoms. Patients with severe infections needed hospitalization and required ventilation support. Patients with underlying liver disease had serious complications like worsening of the disease, severe respiratory symptoms, severe liver damage, and death in most cases. Early detection of the disease and getting appropriate treatment can prolong the lifespan of the patient.