Page 30 - Care-for-vulnerable-populations-during-COVID-19-pandemic

So, what are the mechanisms of liver injuries?

These are postulates. Based on autopsy tissues of the liver, there is a direct viral cytopathic effect
because we could see the moderate microvesicular steatosis and activities in the lobular area and
the portal area of the liver tissue. Also, we can see acute portal & sinusoidal thrombosis, chronic
fibrous endothelial thickening in the liver tissues. Possible there is intrahepatic vascular related
damage as well. Of course, drug induced liver injury can happen. This can be supported by
microvesicular steatosis on autopsy liver tissue. Drug induced liver injury is a diagnosis by
exclusion. In COVID-19 patients, the common drug induced liver injury that we need to
consider, are the antiviral drugs such as Remidesivir, tocilizumab and other drugs such as HCQ,
Kaletra (lopinavir, ritonavir), antifungal and antibiotic. Liver injury can also be happening
because of cytokine storms or immune imbalance where the liver could be part of the multi-
organs dysfunction. Other possible causes could be pneumonia associated hypoxia or ischemic
hepatitis.