Strategies to treat liver damage caused by Covid-19

Posted by Master, Doctor Mai Vien Phuong - Head of Department of Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

Patients with COVID-19 showing liver damage may experience tanning and hyperpigmentation. To definitively determine the presence of liver damage, liver enzymes are the most commonly used marker. Liver biopsy is highly recommended for people with acute liver failure of unknown cause. Viral particles were clearly observed in hepatocytes. However, to date, studies involving liver biopsies in COVID-19 have been limited to case reports. Potential mechanisms of COVID-19-associated liver injury may include direct effects of viral infection, inflammatory storm, hypoxemia, endocarditis, and medications. The S protein-ACE2 interactor may be the main tunnel for viral entry, whose activity may be regulated by multiple factors, such as hypoxia, fibrosis/cirrhosis, and GM1 .
Among patients with chronic liver disease, NAFLD was indicated as an independent factor in relation to ICU admission and mechanical ventilation after adjustment for comorbidities, such as hypertension, diabetes mellitus, and hypertension. fat.

Although liver damage is a complication of COVID-19, most cases of COVID-19 present with mild abnormalities in liver function, which are usually temporary and may return to normal without treatment. any special treatment. According to the China Pharmaceutical Association, a "four against and two balance" strategy is recommended, including anti-viral, anti-shock, anti-oxidative, secondary anti-infective therapy, and maintaining water and nutrients. electrolytes, acid-base and microbiological balance. Patients with COVID-19 who present with obvious liver damage can be treated with hepatoprotective, anti-jaundice, or anti-inflammatory drugs, such as polyene phosphatidylcholine, glycyrrhizic acid, ursodeoxycholic acid, and adenosylmethionine.
For liver damage in critically ill patients with SARS-CoV-2, one or two drugs can be selected to avoid drug abuse and further burden on the liver, while reducing drug interactions. A recent study by Hoever et al revealed that glycyrrhizic acid derivatives, which are favored anti-hepatitis drugs, may also have antiviral activity against SARS-CoV-2. Glycyrrhizic acid has a strong affinity for steroid-metabolizing enzymes in the liver and interferes with the inactivation of cortisol and aldosterone. It also showed obvious corticosteroid-like effects, such as anti-inflammatory, anti-allergic and protective membrane structure, without the obvious cortical hormone-like side effects.

Hu et al retrospectively analyzed the clinical features, susceptibility populations, and treatment strategies of patients with novel coronavirus and showed that the primary approach to managing liver injury due to COVID-19 is to prevent liver injury. Blocks the inflammatory response, regulates hypoxia and provides supportive symptoms.
Conservative oxygen therapy is preferred and ventilator-associated pneumonia should be closely monitored in mechanically ventilated patients. Xu et al showed that the hepatocellular hemodialysis system can improve treatment efficacy in critically ill patients by rapidly removing inflammatory mediators, suppressing cytokine storms, and facilitating for water-electrolyte balance. Similar findings were reported by Liu et al., who showed a trend toward significantly reduced levels of cytokines and inflammatory factors (IL-6 and C-reactive protein) in COVID-19 patients after an artificial liver hemodialysis session. For patients with COVID-19 in whom drug-induced liver injury is suspected, discontinuation or dose reduction should be considered. Better prevention, management, monitoring of liver function and avoiding liver damage play an important role in the treatment of liver damage caused by COVID-19.
Patients with cirrhosis, co-infected with SARS-CoV-2, have a high mortality rate, while whether hepatitis B and liver transplantation increase the severity of COVID-19 disease remains an open question. open. A “four Against and Two Balance” strategy, in which drug abuse that aggravates liver burden should be avoided and prevention is prioritized in management, is recommended for the management of liver injury caused by COVID- 19.

References
Cai Y, Ye LP, Song YQ, Mao XL, Wang L, Jiang YZ, Que WT, Li SW. Liver injury in COVID-19: Detection, pathogenesis, and treatment. World J Gastroenterol 2021; 27(22): 3022-3036 [DOI: 10.3748/wjg.v27.i22.3022]