The liver is one of the major organs targeted by SARS-CoV-2. The S protein of the virus binds to ACE2 receptors to enter host cells in the body. ACE2 is expressed in the liver so the organ is likely affect by both a direct attack from the virus and damage from an overexpression of proinflammatory mediators. To monitor liver health the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is generally used, both being factors indicative of liver damage when at high levels. This ratio can indicate the liver advancing to cirrhosis or fibrosis. In studies of COVID-19 patients it was found that levels of markers of liver function were up to five times more than the upper limits of their normal levels and sometimes even higher. In COVID-19 patients that had passed away, about 78% had high levels of markers of abnormal liver function. With the function of the liver in metabolism and protein production, even small changes in the liver that come with the infection may negatively impact the body's response. By altering liver metabolism, there will be consequences seen in the therapeutic and toxic effects of endogenous substances like the medications being taken by COVID-19 patients.