Liver injury in COVID-19: The current evidence

United European Gastroenterol J. 2020 Jun;8(5):509-519. doi: 10.1177/2050640620924157.


Patients with novel coronavirus disease 2019 (COVID-19) experience various degrees of liver function abnormalities. Liver injury requires extensive work-up and continuous surveillance and can be multifactorial and heterogeneous in nature. In the context of COVID-19, clinicians will have to determine whether liver injury is related to an underlying liver disease, drugs used for the treatment of COVID-19, direct effect of the virus, or a complicated disease course. Recent studies proposed several theories on potential mechanisms of liver injury in these patients. This review summarizes current evidence related to hepatobiliary complications in COVID-19, provides an overview of the available case series and critically elucidates the proposed mechanisms and provides recommendations for clinicians.

Keywords: COVID-19; SARS-CoV2; cholangiocytes; cytokine storm; liver function test; liver injury; lymphopenia.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use
  • Betacoronavirus* / physiology
  • COVID-19
  • COVID-19 Drug Treatment
  • Chemical and Drug Induced Liver Injury / etiology
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / immunology
  • Coronavirus Infections / physiopathology*
  • Cytokines / immunology
  • Humans
  • Liver / pathology
  • Liver / physiopathology
  • Liver / virology
  • Liver Diseases / virology*
  • Liver Function Tests
  • Liver Transplantation
  • Pandemics
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / physiopathology*
  • Risk Factors
  • SARS-CoV-2


  • Antiviral Agents
  • Cytokines