Abnormal liver tests in patients hospitalized with Coronavirus disease 2019: Should we worry?

Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mainly causes acute respiratory disease, but it can also cause multiple organ failure. 14% to 76.3% of Coronavirus disease 2019 (COVID-19) patients have abnormal liver function tests, 1-7 and these patients have been reported to be more likely to progress to severe pneumonia. However, these data come from Chinese populations, and there are no specific data on COVID-19 patients in Europe. This knowledge gap prompted us to study the prevalence of abnormal liver function tests and the relationship between abnormal liver function and clinical outcome in a multicentre cohort study of patients hospitalized with COVID-19 in France. 2 | ME THODS We retrospectively studied a cohort of COVID-19 patients hospitalized in two COVID-19 referral hospitals in France (CHU Montpellier

Mild versus Severe Liver Injury in SARS-CoV-2 Infection

“…Abnormal liver parameters were even more frequently observed in our cohort, in 83 and 88% of the patients at admission and during treatment, respectively. The prevalence in our cohort was higher that what has been reported before in Chinese cohorts but also in a recent French study [ 6 , 7 , 12 ].…”

“…Respiratory symptoms are central to the disease; however, nonrespiratory symptoms have been frequently observed as well [ 3 , 4 , 5 ]. Abnormal liver function has been reported in COVID-19 patients, and its prevalence ranges from 16.1 to 66.6% depending on the patient cohort and the definition of abnormality [ 6 , 7 ].…”

“…Two previous studies have reported an association between abnormal liver function at admission and severity of COVID-19 infection [ 6 , 8 ], while another found no such association after adjusting for multiple confounding factors [ 9 ]. It remains to date unclear if the virus can cause direct damage to the liver or if the observed liver injury is indirectly caused, possibly immune-mediated or due to drug-induced liver injury or multiorgan failure.…”

Letter to the Editor: Statins and COVID‐19: Efficacy Still to Be Proven

“…These results are similar to our own experience of 234 patients admitted with COVID-19 according to World Health Organization (WHO) diagnostic guidelines. [2] In our study, 149 (63.7%) patients were male (mean age [SD], 67 (±14) years), 9 (3.8%) had chronic liver disease, and 64 (27.4%) had diabetes.…”

“…Upon admission, AST was correlated with ALT (r = 0.7; P < 0.005), confirming true hepatic, but not severe, COVID-19-related liver injury. [2] Statins were proposed for their capacity to modulate immune response as in retrospective study by Zhang XJ et al in which patients with statins had better survival and lower biologic inflammatory parameters compared to patients without statins. [3] In our cohort, only 42 (18%) patients were on statins prior to admission compared to 40% in Bloom et al's study.…”