COVID-19 and the Liver: A 2021 Update

Catherine W. Spearman; Alessio Aghemo; Luca Valenti; Mark W. Sonderup


Liver International. 2021;41(9):1988-1998. 

In This Article

Outcomes of SARS-CoV-2 Liver Injury

Liver injury associated with SARS-CoV-2 infection is usually mild and self-limiting. Severe liver injuries correlate with a more severe clinical course reflected by higher rates of intensive care unit admission, mechanical ventilation, renal replacement therapy and mortality.[35,37,40]

A multicentre retrospective study from 10 hospitals in Wuhan, China of 5771 patients with COVID-19 pneumonia documented the median days from symptom onset to acute organ damage and revealed that acute liver injury occurs later in the course of COVID-19.[41] Acute liver injury (ALT >3× ULN) occurred at day 17 [IQR, 13–23] after symptom onset and followed the development of ARDS, acute cardiac injury and acute kidney injury. AST levels were associated with the highest all-cause mortality, risk increasing 4.8-fold with AST between 40 and 120 U/L and 14.9-fold with AST >120 U/L after adjusting for age, gender and co-morbidities.[41]