Cholestatic Liver Injury In Covid-19 Is A Rare And Distinct Entity And Is Associated With Increased Mortality

Current evidence indicates that the development of acute hepatocellular liver injury during coronavirus disease 2019 (COVID-19) is associated with more severe COVID-19 disease.[1] Since SARS-CoV2 is able to enter the liver via the ACE2 receptor proteins located on the epithelium of bile ducts, direct viral cholangiocyte injury is theoretically a possible pathogenic mechanism of the virus resulting in cholestatic liver injury.[2] Supporting this idea: a recent meta-analysis that reported serum alkaline phosphatase (ALP) elevations occurs in up to 13.7% of patients[3], a case series describing the clinical/histologic features of three patients with COVID-19 cholangiopathy[4], and a recent study reporting higher fatality rates in COVID-19 patients with cholestasis.[5].