Covid-19 and Liver Injury: Role of Inflammatory Endotheliopathy, Platelet Dysfunction, and Thrombosis

Hepatol Commun. 2022 Feb;6(2):255-269. doi: 10.1002/hep4.1843. Epub 2021 Nov 10.


Liver injury, characterized predominantly by elevated aspartate aminotransferase and alanine aminotransferase, is a common feature of coronavirus disease 2019 (COVID-19) symptoms caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Additionally, SARS-CoV-2 infection is associated with acute-on-chronic liver failure in patients with cirrhosis and has a notably elevated mortality in patients with alcohol-related liver disease compared to other etiologies. Direct viral infection of the liver with SARS-CoV-2 remains controversial, and alternative pathophysiologic explanations for its hepatic effects are an area of active investigation. In this review, we discuss the effects of SARS-CoV-2 and the inflammatory environment it creates on endothelial cells and platelets more generally and then with a hepatic focus. In doing this, we present vascular inflammation and thrombosis as a potential mechanism of liver injury and liver-related complications in COVID-19.

Publication types

  • Review

MeSH terms

  • Blood Platelet Disorders / immunology
  • Blood Platelet Disorders / physiopathology
  • Blood Platelet Disorders / virology*
  • COVID-19 / immunology
  • COVID-19 / physiopathology*
  • Endothelium, Vascular / immunology
  • Endothelium, Vascular / physiopathology
  • Endothelium, Vascular / virology*
  • Humans
  • Inflammation / immunology
  • Inflammation / physiopathology
  • Inflammation / virology*
  • Liver Diseases / immunology
  • Liver Diseases / physiopathology
  • Liver Diseases / virology*
  • Thrombosis / immunology
  • Thrombosis / physiopathology
  • Thrombosis / virology*