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What are the recommendations on the management of

liver injury in COVID-19?

When we look at the liver function, if it is elevated for COVID-19, you should check for viral
hepatitis B and C; review the medication, in case, it is a drug-induced liver injury. If you
consider this patient could have biliary obstruction or venous thrombosis, then an ultrasound is
indicated. Otherwise, probably it is best not to expose the patient to more injury.
If the liver function is stable and improved, continue to observe. If the liver function worsen,
we should think whether is this ischaemia myositis, cytokine release syndrome or could it be
drug induced liver injury.
There's no specific therapy on the management of liver injury. If the patient is found to have
hepatitis B and you are considering whether the patient may have hepatitis B flare, there is no
contraindication for HBV treatment in patients with COVID-19. The presence of abnormal liver
biochemistries should not contraindicate to using investigational or off-label therapies for
COVID-19 unless AST or ALT > 5x ULN. Regular monitoring of LFT in all hospitalized
COVID-19 is recommended, especially, those on Remdesivir or Tocilizumab.