COVID‐19 and liver disease

Abstract

Since December 2019, patients with unexplained pneumonia have been found in Wuhan, Hubei Province, China, which was caused by a novel coronavirus that had not been previously identified.1 Tentatively defined as 2019 novel coronavirus (2019-nCoV), the pathogen has now been named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2),2 while the disease is termed Coronavirus Disease 2019 (COVID-19). On 12 March 2020, the World Health Organization (WHO) declared that COVID-19 constitutes a pandemic. As of 5 April 2020, the world has reported 1,218,090 confirmed cases of COVID-19 with 65,836 deaths (case fatality rate 5.4%), finding healthcare systems unprepared to tackle this threat. For this reason, governments, doctors, health workers, scientists and all citizens must cooperate worldwide to slow-down COVID-19 spread, contain the damage and find effective cures and preventive measures. Here we will provide a short and schematic overview of the implications for clinical hepatologists and researchers in the field based on the first available data. COVID-19 is typically characterized by symptoms of viral pneumonia such as fever, fatigue, dry cough, anosmia and headache, which may evolve to respiratory failure.3, 4 Because of the ubiquitous distribution of the main viral entry receptor, namely angiotensin converting enzyme 2 (ACE2), SARS-CoV-2 causes a systemic disease, with possible involvement of the heart, the liver, the pancreas and the kidneys, as well as determines alterations in circulating lymphocytes and the immune system.4-7 COVID-19-associated liver injury is defined as any liver damage occurring during disease progression and treatment of COVID-19 in patients with or without pre-existing liver disease. Overall, the incidence of elevated serum liver biochemistries in hospitalized patients with COVID-19, primarily elevated AST and ALT and slightly elevated bilirubin, ranges from 14% to 53%.4, 8-14 Increased liver enzymes are observed more commonly in males and in more severe than in milder cases. Low albumin is a marker of severe infection and poor prognosis.15 To date, there is no report of acute or acute on chronic liver failure in COVID-19 patients.4, 8-13 The largest cohort study enrolling 1,099 COVID-19 cases from China showed that 21 (2.1%) had pre-existing hepatitis B. Overall ALT elevation occurred in 21.3% (158/741), and AST elevation in 22.2% (168/757). Severe patients had a higher probability of ALT elevation, compared with non-severe patients (28.1% vs 19.8%), as well as AST elevation (39.4% vs 18.2%). Overall, 10.5% (76/722) patients presented with abnormal bilirubin.14 Liver International will not miss the opportunity to support hepatologists and liver researchers in fighting and finally stopping the pandemic. We have several associate editors who are both experts in liver disease as well as in infectious diseases, with direct clinical and research experience in the field. Therefore, authors are encouraged to submit high-quality scientific manuscripts regarding COVID-19. The turnaround time will be less than 1 week. We guarantee to provide free-access for all accepted papers related with COVID-19, which will be highlighted in a special section in the website.8