MERS-CoV
Several studies report patients with MERS-CoV and elevated liver enzymes, as well as hypoalbuminemia59 , 60 (Table 2). The degree of hypoalbuminemia also helps to predict disease severity.60 Hepatic findings may resemble SARS-CoV-related changes.61 However, MERS-CoV utilizes dipeptidyl peptidase-4 to infect cells, which is highly expressed in the liver.62 , 63 In transgenic mice, the liver injury occurred within the first week after infection resulting in hepatic necrosis and infiltration of Kupffer cells and macrophages.64 Similar to other coronavirus infections, high concentrations of inflammatory cytokines are noted in the acute phase, including IFN-g, TNF-a, IL-15 and IL-17.65 Future investigations may clarify the role of inflammatory response in causing the liver injury.