The link between long covid and severe liver injury and stiffness explained

The effects of long COVID on severe liver injury and liver stiffness are becoming increasingly apparent as more research is conducted. Recent study has shown that covid infection can cause increase in liver stiffness. The liver stiffness is a surrogate marker for liver fibrosis (scarring of the liver) and was measured by using shear wave elastography. Those people who got covid infection were more likely to have increased stiffness of liver. This suggests that the injury to the liver may not be limited to just increased liver enzymes transiently during the infection but persistent scarring and damage to the liver way beyond the covid infection.

Severe liver injury can lead to a buildup of scar tissue in the organ, resulting in impaired function, said Dr. Chetan Ramesh Kalal, Liver Transplant Physician, Masina Hospital, Byculla, Mumbai.

Additionally, recent studies have suggested that long COVID may cause an increased level of liver stiffness due to inflammation from cytokines released during persistent infection or elevated levels of endotoxins. Elevated levels of endotoxins can cause increased fibrosis which increases the risk for further complications such as portal hypertension or cirrhosis, he said.

According to Dr. Akash Shukla,Director and Consultant in Department, Hepatology at Sir H. N. Reliance Foundation Hospital and Research Centre, covid virus has a special affinity to the cholangiocytes, cells which line the bile duct within and outside the liver. Additionally, liver being the largest immune organ of the body is the target of antigen-antibody complexes following covid infection. Therefore, covid, tends to affect the liver in over half of the cases. Most often, this liver affection is asymptomatic and is diagnosed by transient elevation of liver enzymes like SGOT & SGPT. However, occasionally the liver injury is more severe and can cause acute hepatitis and manifest as jaundice. Those patients who have pre-existing liver disease especially cirrhosis have a risk of development of worsening of liver disease with covid infection.

Dr. Chetan Ramesh said that long term symptoms associated with long covid have also been shown to include fatigue and malaise which could further exacerbate underlying conditions and potentially worsen any existing cases of severe liver injury or fibrosis leading to increased rigidity within the organ over time.

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