The mechanisms of liver injury in patients with COVID-19 infection are direct cytopathic damage by SARS-COV-2 binding to cholangiocytes expressing ACE-2, cytokine storm, systemic inflammatory response syndrome (SIRS)-induced cholestasis, ischemia hypoxia reperfusion injury, and drug-induced liver injury [119,125,129,130]. Here, ACE2 is linked to systemic inflammatory response syndrome.