covid-19 and hepatic encephalopathy: a narrative review

The 2019 novel coronavirus (covid-19) has been known as a highly pandemic virus that is characterized by a severe multiorgan pathology. generally, cardio-respiratory complications are the dominant manifestations in patients infected with covid-19. since the coronavirus targets angiotensin-converting enzyme (ace) receptors, however, the virus is also likely to exhibit multiorgan complications. some retrospective cohorts as well as case studies have shown varying degrees of increased alanine transaminase (alt)/aspartate transaminase (ast) in covid-19 infections. a limited number of histopathological studies examining the liver have also reported an acute portal necrosis of this organ. some other studies investigating the patients with covid-19 have documented an acute hepatic encephalopathy with altered mental status. beyond doubt, having a greater awareness of these complications positively contributes to timely and effective management and treatment of the patients. the present review article, therefore, aimed to highlight the consequences of developing hepatic encephalopathy for patients with covid-19, its possible multifaceted mechanisms, and the management of neurological complications in these infected patients.