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Characteristics of Liver Tests in COVID-19 Patients
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April 13 2020 Jnl of Hepatology - Qingxian Cai, PhD, Deliang Huang, MD, Hong Yu, MD, Zhibin Zhu, MD, Zhang Xia, MD, Yinan Su, MD, Zhiwei Li, MD, Guangde Zhou, MD, Jizhou Gou, MD, Jiuxin Qu, MD, Yan Sun, MD, Yingxia Liu, MD, Qing He, MD, Jun Chen, PhD, Lei Liu, MD, Lin Xu, PhD
Highlight
• Of 417 patients with COVID-19 in a referral hospital in Shenzhen, 76.3% had abnormal liver tests and 21.5% had liver injury during hospitalization.
• Patients with abnormal liver tests, especially in hepatocyte type or mixed type, had significantly higher odds of developing severe pneumonia.
• The use of lopinavir/ritonavir increased the odds of liver injury by 7-fold.
Abstract
Background & Aims
Recent data on the coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has begun to shine light on the impact of the disease on the liver. But no studies to date have systematically described liver test abnormalities in patients with COVID-19. We evaluated the clinical characteristics of COVID-19 in patients with abnormal liver tests.
Methods
Clinical records and laboratory results were obtained from 417 laboratory-confirmed COVID-19 patients who were admitted to the only referral hospital in Shenzhen, China from January 11 to February 21, 2020 and followed up to March 7, 2020. Information of clinical features of patients with abnormal liver tests were collected for analysis.
Results
Of 417 patients with COVID-19, 318 (76.3%) had abnormal liver test results and 90 (21.5%) had liver injury during hospitalization. The presence of abnormal liver tests became more pronounced during hospitalization within 2 weeks, with 49 (23.4%), 31 (14.8%), 24 (11.5%) and 51 (24.4%) patients raising liver enzyme levels to more than 3 times of upper limit units in alanine aminotransferase, aspartate aminotransferase, total bilirubin and gamma-glutamyl transferase, respectively. Patients with abnormal liver test of hepatocellular type or mixed type at admission had higher odds of progressing to severe disease (odds ratios (OR)=2.73, 95% confidence interval (CI) 1.19-6.3, and 4.44, 95% CI 1.93-10.23, respectively). The use of lopinavir/ritonavir was also found to lead to increased odds of liver injury (OR from 4.44 to 5.03, both P<0.01).
Conclusion
Patients with abnormal liver tests had higher risks of progressing to severe disease. The detrimental effects on liver injury mainly related to certain medications used during hospitalization, should be monitored and evaluated frequently.
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