A clinical case of disorders of hepatic function and possibilities of their correction after COVID-19 based on foreign and domestic recommendations

Due to the complex epidemiological situation resulting from the infection of COVID‑19, doctors of various specialties have a number of questions regarding the tactics of patients’ management. Current data indicate that SARS‑CoV‑2 has the ability to affect all organs and systems of the body, including the gastrointestinal tract. Liver is one of the target organs, affected by COVID‑19 infection. The authors consider the latest foreign and domestic recommendations for the treatment of patients with hepatic lesions. A clinical case of hepatic dysfunction and possibilities of its correction after COVID‑19 have been outlined. The main pathogenetic mechanisms of changes in liver samples are highlighted, including immune activation and inflammation caused by cytokines with the initiation of cytokine storm, coagulopathy and multiple organ failure, cytotoxicity due to virus replication in cholangiocytes and hepatocytes with the participation of angiotensin‑converting enzyme‑2 and serine protease‑2 receptors, severe hypoxia caused by vascular endothelium damage, drug‑induced liver damage caused by hepatotoxicity and immune‑mediated damage, reactivation of previously existing liver diseases (hepatitis, non‑alcoholic fatty liver disease, as well as progression and decompensation of liver cirrhosis). The domestic algorithm for the management of patients with liver diseases, hospitalized with confirmed COVID‑19 infection, involves the control of liver samples once every 2 — 3 months, annual control of fibrosis degree, correction of diet and lifestyle, minimization of drug therapy, administration of drugs (hepatoprotectors) and correction of microcirculation processes and functions of other organs/systems. 
The presented clinical case demonstrates the importance of timely treatment of liver functional disorders and the need for dynamic monitoring of the condition of patients who have contracted COVID‑19. 
 