Table 2 Environmental risk factors demonstrated in classes and types with possible mechanisms and outcomes that may contribute to SIH in patients with COVID-19
From: Liver injury in COVID-19: an insight into pathobiology and roles of risk factors
Risk factors | Possible mechanisms & outcomes | Reference | ||
|---|---|---|---|---|
Category | Class | Type | ||
Environmental factors | Dietary habits | Carbohydrates | - Obesity - Insulin resistance - NAFLD & NASH - Type 2 diabetes - Liver cirrhosis | 62, 63 |
Saturated fatty acids | ||||
Unhealthy behavior | Low physical activity | - Higher chances of inflammation status - Cardiovascular diseases - Obesity - Immune-related issues - Prone to developing CLDs | 64, 65 | |
Smoking | - Overexpression of ACE-2 by upregulation of nAChRs a | 66 | ||
Alcohol drinking | - ALD - Liver cirrhosis | 7 | ||
Drug abuse | - Disturbing the activity of HPA b axis - Excessive production of ACTH c & glucocorticoids which suppress the immune system and increase the likelihood of viral invasion | 67 | ||
Impaired sleep | - Increasing the BBB d permeability - Release of inflammatory cytokines - Release of acute-phase proteins | 68 | ||
Overeating | - Increase of adipose tissue - Oversecretion of inflammatory adipokines including IL-6 | 63–65 | ||
Hepatotoxic drugs | Chloroquine & hydroxychloroquine | - On-target toxicity: The pharmaceutical target site and that of the undesired effect are both the same. - Off-target toxicity: The pharmaceutical target site and that of the undesired effect are different places. - Hypersensitivity: It is the result of an unbalanced immune response to an unknown substance. - Bio-activation toxicity/antagonist interference: Molecular alterations of prodrugs may interact with receptors or regulators and interfere with their usual activity. | 40, 57, 70–72 | |
Lopinavir/ritonavir | ||||
Ribavirin | ||||
Favipiravir | ||||
Remdesivir | ||||
Tocilizumab | ||||