Changing Features of Liver Injury in COVID-19 Patients: Impact of Infection with the SARS-CoV-2 Delta (B.1.617.2) Variants

Abstract

Background There is growing evidence that abnormal liver function tests (LFTs) are common in patients with coronavirus disease 2019 (COVID-19). However, it is not known whether viral involvement in the liver differs according to the strain. We investigated the impact on liver injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) variants. Materials and Methods We conducted a single-center, retrospective cohort study, including 372 patients admitted during the pre-Delta period (PDP: between February 1 and November 30, 2020) and 137 patients admitted during the Delta period (DP: between August 1 and August 31, 2021). Initial liver injury was defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels ≥3 × the upper limit of normal (ULN) or alkaline phosphatase (ALP) or total bilirubin ≥2 × the ULN within 3 days from admission. Results Of 509 patients with COVID-19 included in our study, 38 (7.5%) patients had initial liver injury. The DP group had a significantly higher rate of initial liver injury than the PDP group (PDP: 5.9% vs. DP: 11.7%, P = 0.028). The DP group (adjusted odds ratio [aOR]: 2.737, 95% confidence interval [CI]: 1.322 – 5.666) was independently associated with initial liver injury. During hospitalization, 160 (31.4%) patients had severe COVID-19. The DP group and initial liver injury had higher odds of progressing to severe COVID-19 (aOR: 2.664, 95% CI: 1.526 - 4.648, and aOR: 4.409, 95% CI: 1.816 - 10.707, respectively). The mediation analysis suggested that initial liver injury mediates the relationship between SARS-CoV-2 Delta variant infection and severe COVID-19 (unstandardized beta coefficient = 0.980, Standard error = 0.284, P = 0.001). Conclusion Initial liver injury is more common in COVID-19 patients with Delta variants. Also, Delta variants and initial liver injury are associated with poor clinical outcomes.

Effects of SARS-CoV-2 on Pulmonary Function and Muscle Strength Testing in Military Subjects According to the Period of Infection: Cross-Sectional Study

“…There are not many studies exploring the effect of the different variants on clinical presentations, and as in our study, the SARS-CoV-2 variant was inferred from the period of infection. For example, a recent study demonstrated that liver injury is more common in patients infected with Delta variants [34], and the studied patients were divided into "pre-Delta period" if they were infected between 1 February and 30 November 2020 or in the Delta period between 1 August and 31 August 2021. Yoon et al [35] compared the pulmonary involvement at the Chest CT scan in 88 patients with the Omicron variant to 88 patients with the Delta variant and demonstrated that in hospitalized patients with similar disease severity, the Omicron SARS-CoV-2 variant showed nontypical peribronchovascular pneumonia and less pulmonary vascular involvement than the Delta variant.…”

“…Moreover, the follow-up differs between groups, although it was longer in Group A with the worst PFTs, that which could suggest an underestimation of their values and so a bigger difference between groups. Some data are missing, mainly on HGT, as well as the possibility of comparing pulmonary function tests before SARS-CoV-2 infection for an assessment of the real impact of infection on lung function [34]. Moreover, the Chest CT scan was not performed for all subjects, and a qualitative analysis was performed.…”

Liver manifestations in COVID-19 patients: A review article

“…In a retrospective cohort study conducted by Phipps et al [ 18 ] on 2273 COVID-19 patients in the United States, 45% had mild, 21% had moderate, and 6.4% had a severe liver injury[ 18 ]. The severity of liver injury was significantly associated with the severity of the COVID-19 disease[ 19 ]. Moderate and severe liver injury was found to be more common in patients who required admission to the Intensive Care Unit[ 18 ].…”

“…Moderate and severe liver injury was found to be more common in patients who required admission to the Intensive Care Unit[ 18 ]. However, even asymptomatic infected patients with COVID-19 have the same viral load, and consequently, liver damage can happen with elevation of liver enzymes, but to a lesser extended than the severe symptomatic patients[ 19 ]. Liver injury is more common in patients with high viral load.…”

“…Liver injury is more common in patients with high viral load. Thus, the risk of initial liver injury may be increased in patients infected with Delta mutations and having relatively large viral loads[ 19 ]. A study by Deng et al [ 20 ] compared liver injury in patients with Delta and Omicron variant-infected patients.…”