A limited role of cytokine storm and fibrogenesis in COVID-19 related liver injury.

Symptomatic transaminases elevations are common in coronavirus disease 2019 (COVID-19). In approximately 23% of all patients elevated transaminases are seen. COVID-19 related liver injury may be caused by primary liver injury but also as collateral damage related to drug-induced-liver-injury, hypoxia, and preexisting liver disease [1]. Hepatitis may aggravate disease severity, and lead to mortality. In this context, it is important to understand the impetus for liver injury [2].We performed a multimodality approach to dissect the contributing factors to liver injury in a well-defined cohort of COVID-19 patients. The aim was to explore inflammatory and fibrosis biomarkers and their relation to pre-existing liver disease. We examined a cohort of 25 patients (mean age 57.9 years, male 72%, median body mass index 27.3 kg/m2) who were hospitalized in 2020 in the Radboudumc, Nijmegen, The Netherlands. All presented with COVID-19 infection established on basis of a positive polymerase chain reaction LETTERS TO THE EDITOR