Hepatobiliary and Pancreatic Manifestations of Coronavirus Disease 2019
Coronavirus disease 2019 (COVID-19) is a new infectious disease that has spread rapidly throughout the world. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Coronaviridae family. Though the pulmonary involvement is a major cause of morbidity and mortality, involvement of the gastrointestinal tract, liver, and pancreas has been explained in these patients. The literature is rapidly changing because of influx of new information with every passage of time. The most common hepatic presentation is mild elevation of aspartate transaminase and alanine transaminase, which does not require specific treatment. Occasionally, patients can have severe liver injury. Because of underlying predisposing factors such as diabetes mellitus, hypertension, and obesity, patients with nonalcoholic liver disease may be at risk of severe disease. Patients with decompensated liver disease may also be vulnerable to severe disease. Behavior of SARS-CoV-2 in patients with chronic hepatitis B and C, autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cirrhosis is yet to be seen. The prevalence and severity of COVID-19 patients with the aforementioned diseases may be different. The effect of SARS-CoV-2 on an underlying liver disease is not known. COVID-19 may complicate the peritransplant period and throw new challenges in these patients. Drugs used to treat severe COVID-19 may cause liver injury and may have an effect on the underlying disease activity. Both hepatic and pancreatic involvement is related to the severity of COVID-19 disease. Serum amylase and lipase levels may be elevated in patients with severe COVID-19 disease. The involvement of pancreatic islet cells may lead to deranged blood sugar levels and potentially predispose to future diabetes mellitus. There are many unknown facts that will unfold with the passage of time.
Keywordscoronavirus disease 2019 - hepatobiliary - pancreatic - severe acute respiratory syndrome coronavirus 2
16. Mai 2020 (online)
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- 1 Su S, Wong G, Shi W. et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol 2016; 24 (06) 490-502
- 2 Cavanag D. Coronavirus avian infectious bronchitis virus. Vet Res 2007; 38 (02) 281-297
- 3 Ismail MM, Tang AY, Saif YM. Pathogenicity of turkey coronavirus in turkeys and chickens. Avian Dis 2003; 47 (03) 515-522
- 4 Peiris JS, Yuen KY, Osterhaus AD, Stöhr K. The severe acute respiratory syndrome. N Engl J Med 2003; 349 (25) 2431-2441
- 5 Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367 (19) 1814-1820
- 6 Al-Omari A, Rabaan AA, Sali S, Al-Tawfiq JA, Memis ZA. MERS coronavirus outbreak: implications for emerging viral infections. Diagn Microbiol Infect Dis 2019; 93 (03) 265-285
- 7 Anderson LJ, Baric RS. Emerging human coronaviruses–disease potential and preparedness. N Engl J Med 2012; 367 (19) 1850-1852
- 8 Zhu N, Zhang D, Wang W. et al. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in china. N Engl J Med 2019; 20 (382) 727-733
- 9 Li F, Li W, Farzan M, Harrison SC. Structure of SARS coronavirus spike receptor-binding domain complexed with receptor. Science 2005; 309 (5742) 1864-1868
- 10 Lu G, Hu Y, Wang Q. et al. Molecular basis of binding between novel human coronavirus MERS-CoV and its receptor CD26. Nature 2013; 500 (7461) 227-231
- 11 Lu R, Zhao X, Li J. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395 (10224) 565-574
- 12 Tai W, He L, Zhang X. et al. Characterization of the receptor-binding domain (RBD) of 2019 novel coronavirus: implication for development of RBD protein as a viral attachment inhibitor and vaccine. Cell Mol Immunol 2020; (e-pub ahead of print) DOI: 10.1038/s41423-020-0400-4.
- 13 Holshue ML, DeBolt C, Lindquist S. et al. Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382 (10) 929-936
- 14 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223) 507-513
- 15 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.1585.
- 16 Lee N, Hui D, Wu A. et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003; 348 (20) 1986-1994
- 17 Tsang KW, Ho PL, Ooi GC. et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003; 348 (20) 1977-1985
- 18 Chau TN, Lee KC, Yao H. et al. SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology 2004; 39 (02) 302-310
- 19 Alsaad KO, Hajeer AH, Al Balwi M. et al. Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection - clinicopathological and ultrastructural study. Histopathology 2018; 72 (03) 516-524
- 20 Chai X, Hu L, Zhang Y. et al. Specific ACE2 expression in cholangiocytesmay causeliver damage after 2019-nCoV infection. bioRxiv 2020; (e-pub ahead of print) DOI: 10.1101/2020.02.03.931766.
- 21 Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020; 5 (05) 428-430
- 22 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223) 497-506
- 23 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; (e-pub ahead of print) DOI: 10.1016/S2213-2600(20)30079-5.
- 24 Qin J, Wang H, Qin X. et al. Perioperative presentation of COVID-19 disease in a liver transplant recipient. Hepatology 2020; (e-pub ahead of print) DOI: 10.1002/hep.31257.
- 25 Wang F, Wang H, Fan J, Zhang Y, Wang H, Zhao Q. Pancreatic injury patterns in patients with COVID-19 pneumonia. Gastroenterology 2020; (e-pub ahead of print) DOI: 10.1053/j.gastro.2020.03.055.
- 26 Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 2010; 47 (03) 193-199