Hepatobiliary complications in patients with covid-19: an integrative review
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i6e-209103Keywords:
Hepatobiliary Diseases, COVID-19, Gastrointestinal, Pathophysiology, LiverAbstract
Introduction: During the clinical course of COVID-19, liver injury has been observed to occur in a significant proportion of patients, especially in those with severe or critical illness. Objective: To synthesize the available information covering the mechanisms of COVID-19-induced hepatobiliary injury. Methods: This is an integrative literature review in PubMed and VHL databases using the descriptors: “Hepatobiliary Diseases”, “COVID-19”, “Gastrointestinal”, “Pathophysiology” and “Liver”. To refine the search the Boolean operators “AND” and “OR” were used, and articles relevant to the topic were selected. Initially, 193 articles were selected, from the last 10 years, in Portuguese and/or English. After analysis, 18 articles corresponded to the proposed objective. Results: Liver dysfunction was observed in 14 to 53% of COVID-19 patients, especially in those with severe disease. This is due to the postulated mechanism of viral entry through angiotensin-converting enzyme 2 receptors that are abundantly present not only in alveolar type 2 cells, but also in the gastrointestinal tract, vascular endothelium, and liver cholangiocytes. Liver involvement in COVID-19 is related to direct SARS-CoV-2 injury to the liver, systemic inflammatory reaction, liver injury from hypoxia, ischemia and reperfusion, aggravation of liver injury due to association of preexisting liver diseases with COVID-19, and drug-induced liver injury. Conclusion: Liver function disorders, especially hypoalbuminemia, elevated GGT and aminotransferase, are frequent in patients with COVID-19 disease. Even patients with severe disease, are more likely to present these liver function disorders.
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