Hepatic manifestations and impact of COVID-19 on the cirrhotic patient

• Published in: Revista de Gastroenterología de México (English Edition) 2020-07, Vol.85 (3), p.303-311
• Main Authors: Velarde-Ruiz Velasco, J.A., García-Jiménez, E.S., Remes-Troche, J.M.
• Format: Article
• Language: English
• Subjects: Cirrhosis; Cirrosis; Coronavirus; Coronavirus Infections - complications; Coronavirus Infections - physiopathology; Coronavirus Infections - prevention & control; Coronavirus Infections - therapy; COVID-19; Hepatitis; Humans; Hígado; Incidence; Liver; Liver - physiopathology; Liver Cirrhosis - complications; Liver Cirrhosis - epidemiology; Liver Cirrhosis - physiopathology; Liver Cirrhosis - therapy; Liver Diseases - etiology; Liver Diseases - physiopathology; Liver Diseases - therapy; Pandemics - prevention & control; Pneumonia, Viral - complications; Pneumonia, Viral - physiopathology; Pneumonia, Viral - prevention & control; Pneumonia, Viral - therapy; SARS-CoV2
• ISSN: 2255-534X; 2255-534X
• DOI: 10.1016/j.rgmxen.2020.05.002

The novel SARS-CoV-2 coronavirus is responsible for the infectious disease caused by coronavirus 19 (COVID-19). The current pandemic is growing worldwide and could affect 50-60% of the world population in the months to come. The most severe disease manifestations are atypical pneumonia and sepsis, but the gastrointestinal tract, particularly the liver, has recently been reported to be affected by SARS-CoV-2. Therefore, the aim of the present work was to review the literature available on the topic and provide information about COVID-19, in both healthy and diseased livers, and issue recommendations. The incidence of liver injury specifically associated with COVID-19 varies from 14.8-53%. The majority of case series have reported altered ALT and AST, elevated total bilirubin, and low serum albumin and liver compromise has been associated with the most severe cases of COVID-19. Cirrhosis of the liver has a recognized immune dysfunction status that includes immunodeficiency and systemic inflammation, making it reasonable for those patients to be more susceptible to SARS-CoV-2 infection. The recommendations for those patients, in addition to the general measures of physical distancing and handwashing for all persons, include social, medical, and psychologic support during the period of home quarantine to prevent lapses in treatment. Patients should be made aware that they need to keep abreast of changes in recommendations and social policies. El coronavirus SARS-CoV-2, un nuevo coronavirus, es responsable de la enfermedad infecciosa por coronavirus 19 (COVID-19). A nivel global, esta pandemia va en crecimiento y pudiera afectar al 50-60% de la población mundial en los siguientes meses. Si bien es una enfermedad cuya manifestación más severa es la neumonía atípica y sepsis, recientemente se ha descrito que el tracto digestivo y en particular el hígado, pueden verse afectados por el SARS-CoV-2. Así pues, el objetivo del presente trabajo es revisar la literatura disponible al respecto y emitir algunas recomendaciones del papel que el COVID-19 ejerce sobre el hígado en la salud y la enfermedad. La incidencia de lesión hepática asociada específicamente a COVID-19 varía de 14.8-53%. La mayoría de las series de casos han reportado alteración en ALT y AST, elevación de bilirrubinas totales y albúmina sérica baja. La afectación hepática se ha asociado a casos más graves de COVID-19. Por otra parte, se reconoce que la cirrosis hepática es un estado de disfunción inmune