COVID-19 and Liver Disease—What We Know on 1st May 2020

Review Article

Isabel Garrido; Rodrigo Liberal; Guilherme Macedo


Aliment Pharmacol Ther. 2020;52(2):267-275. 

In This Article

Abstract and Introduction


Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), became a global threat to human health. Liver impairment has been frequently reported as a common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver disease (CLD).

Aims: To summarise the changes in liver function tests during SARS-CoV-2 infection and the impact of COVID-19 in patients with underlying CLD.

Methods: A literature review using online database PubMed was done using the search terms "SARS-CoV-2", "COVID-19", "liver", "cirrhosis" and "liver transplantation".

Results: COVID-19 is frequently associated with different degrees of abnormal liver function tests, most notably transaminases, which are usually transitory and of mild degree. Available evidence suggests that liver injury may result from direct pathogenic effect by the virus, systemic inflammation or toxicity from commonly used drugs in this subset of patients. SARS-CoV-2 infection in children is associated with minimal or no increase in liver enzymes, thus the presence of abnormal liver function tests should trigger evaluation for underlying liver diseases. Although it seems that patients with CLD are not at greater risk for acquiring the infection, those with cirrhosis, hepatocellular carcinoma, non-alcoholic fatty liver disease, autoimmune liver diseases or liver transplant may have a greater risk for severe COVID-19.

Conclusions: Abnormal liver function tests during the course of COVID-19 are common, though clinically significant liver injury is rare. Further research is needed focusing on the effect of existing liver-related comorbidities on treatment and outcome of COVID-19.


Coronavirus disease 2019 (COVID-19) is caused by the recently identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initially reported in Wuhan, China, but that rapidly spread around the world and caused a serious threat to global public health.[1] Similar to SARS-CoV, SARS-CoV-2 mainly affects the respiratory system, with fever, cough and dyspnoea being the most frequently reported symptoms.[2] In severe cases, patients may develop pneumonia and associated complications, such as severe acute respiratory distress syndrome, septic shock and, eventually, death.[3] Liver impairment has also been reported as a common manifestation, although its clinical significance is still unclear. Moreover it is important to define if chronic liver disease (CLD) should be considered a risk factor for severe disease course. Thereby, we aimed to review the changes in liver function caused by SARS-CoV-2, in both adults and children, and the impact of COVID-19 in patients with CLD. In addition, we overview some of the therapies for COVID-19 under investigation and their risk of drug-induced hepatotoxicity.