Liver Injury in the Context of SARS-CoV-2 Infection: Facts, Causes and Consequences. Summary of the Doctoral Thesis

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dc.contributor.advisorVīksna, Ludmila
dc.contributor.advisorRozentāle, Baiba
dc.contributor.authorVanaga, Ieva
dc.date.accessioned2025-06-03T12:20:39Z
dc.date.available2025-06-03T12:20:39Z
dc.date.issued2025
dc.descriptionThe Doctoral Thesis was developed at the Department of Infectology of Rīga Stradiņš University in cooperation with the Institute of Microbiology and Virology of Rīga Stradiņš University and the Riga Eastern Clinical University Hospital, Latvia. Defence: at the public session of the Promotion Council of the Clinical Medicine on 2 June 2025 at 15.00 in the Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīgas Stradiņš University and remotely via online platform Zoom.en
dc.description.abstractThe novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first identified in China in late 2019, has caused the most significant infectious disease pandemic of the 21st century (Kumar (ed.), 2021). In less than five years, more than 775 million COVID-19 cases and more than 7 million deaths have been reported worldwide (WHO Data, COVID-19, 2024). The Doctoral Thesis “Liver injury in the context of SARS-CoV-2 infection: facts, causes and consequences” is dedicated to studying liver damage caused by the new coronavirus infection. The research began in early 2020 when the first reports of COVID-19 cases appeared (Spiteri et al., 2020), complicated in some patients by hypoxia. The knowledge that the liver is one of the most sensitive organs to respond to hypoxia (Xu et al., 2021), resulting in tissue damage (Imtiyaz et al., 2010; Zorov et al., 2014), led to the hypothesis that also patients with COVID-19 may develop liver damage. This is also supported by the first published reports on liver pathology in patients with COVID-19 (Zhang et al., 2020; Guan et al., 2020; Richardson et al., 2020; Zhong et al., 2020). This Doctoral Thesis study is one of the first comprehensive studies on liver damage in COVID-19 patients conducted over a long period. The study aimed to assess the liver status of COVID-19 patients in the acute phase of the disease and its dynamics after 18 to 36 months, to identify factors associated with liver damage and to evaluate possible long-term consequences. Most (139) of the patients were hospitalised during the acute phase of the disease when their liver condition was assessed. The dynamics of the liver condition of hospitalised patients after 18–36 months were evaluated in 72 persons (group A). The health status of some (54) patients included in the study was comprehensively observed 3–9 months after the onset of the disease and in dynamics in 52 persons 18–36 months after the disease (group B). Liver cell damage and the processes of inflammation, apoptosis, and fibrosis and their interrelationships were assessed. Liver status was assessed using several modern non-invasive diagnostic methods, including markers of liver apoptosis and fibrosis, magnetic resonance imaging (MRI), computed tomography (CT), as well as multiparametric ultrasonography (mpUS). In addition, various factors potentially influencing liver status were analysed, including human leukocyte antigen (HLA) class II gene alleles, sociodemographic factors, and autoimmunity. Studying these processes is important for better understanding the pathogenetic mechanisms of liver damage caused by SARS-CoV-2 infection, as well as influencing factors and long-term changes. It was found that liver damage developed in more than one third of patients, and one in ten (11 %) patients had severe liver injury during the acute COVID-19 period. Liver damage in the acute COVID-19 period was associated with the severity of COVID-19 and the medications used. Several mechanisms were implicated, including hypoxia. However, the most significant role in the development of liver damage was played by the apoptosis of epithelial tissues, which is associated with the direct effect of the SARS-CoV-2 virus. An association was also established between hepatocellular liver damage, apoptosis and fibrosis markers with HLA class II gene alleles. In the early post-COVID period, 3–9 months after the onset of the disease, some patients retained signs of liver cell damage and increased activity of apoptosis and fibrosis processes. However, in most patients, liver damage was not persistent over time and recovery was observed within 18–36 months, including a decrease in apoptosis, fibrosis markers and mpUS liver shear wave dispersion (SWD) indicators. Liver damage remained in a small number of individuals. In the post-COVID-19 period, the dynamics of liver sound attenuation phenomenon (ATI) indicators in mpUS increased. The persistence of liver damage was associated with the COVID-19 severity and liver injury in the acute period of the disease. In addition, in individuals whose liver damage was detected 18–36 months after COVID-19, it was associated with several cardiometabolic risk factors, including lower high-density lipoprotein (HDL) cholesterol levels in the blood. No direct relationship was established between post-COVID-19-related conditions and liver damage. However, associations were found with several indicators of liver damage, including antibodies to soluble liver antigen (anti-SLA), which are characteristic of autoimmune diseases, and liver shear wave elastography (SWE) indicators on multiparametric ultrasound. Further investigation of these processes is needed to clarify the dynamics of liver damage over a longer period.en
dc.formatElectronic
dc.identifier.citationVanaga, I. 2025. Liver Injury in the Context of SARS-CoV-2 Infection: Facts, Causes and Consequences: Summary of the Doctoral Thesis: Sub-Sector – Internal medicine, Hepatology. Rīga: Rīga Stradiņš University. https://doi.org/10.25143/prom-rsu_2025-12_dtsen
dc.identifier.doihttps://doi.org/10.25143/prom-rsu_2025-12_dts
dc.identifier.other1–68
dc.identifier.urihttps://dspace.rsu.lv/handle/123456789/1038508
dc.language.isoen
dc.publisherRīga Stradiņš Universityen
dc.rightsAttribution-NonCommercial 4.0 International
dc.rightsinfo:eu-repo/semantics/openAccess-
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectSummary of the Doctoral Thesisen
dc.subjectliver injuryen
dc.subjectSARS-CoV-2 infectionen
dc.subjectfibrosisen
dc.subjectapoptosisen
dc.subjectimmunogeneticsen
dc.subject.other3.2. Clinical Medicine; Sub-Sector – Internal medicine, Hepatologyen
dc.titleLiver Injury in the Context of SARS-CoV-2 Infection: Facts, Causes and Consequences. Summary of the Doctoral Thesisen
dc.title.alternativeAknu bojājums SARS-CoV-2 infekcijas kontekstos: fakti, iemesli un sekas. Promocijas darba kopsavilkumslv_LV
dc.typeinfo:eu-repo/semantics/other

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