Clinical characteristics and risk factors of liver injury in COVID-19: a retrospective cohort study from Wuhan, China

Abstract

Background Coronavirus disease 2019 (COVID-19) has rapidly become a major international public health concern. This study was designed to evaluate the clinical characteristics and risk factors of COVID-19-associated liver injury. Methods A fraction of 657 COVID-19 patients were retrospectively analyzed. Clinical and laboratory data were derived from electronic medical records and compared between patients with or without liver injury. Multivariate logistic regression method was used to analyze the risk factors for liver injury. Results Among 657 patients, 303 (46.1%) patients had liver injury with higher rate in severe/critically ill patients [148/257 (57.6%)] than those in moderate cases [155/400 (38.8%)]. The incidence of liver injury was much higher in male [192/303 (63.4%)] than female [111/303 (36.6%)], and in severe/critical patients [148/303 (48.8%)] with percutaneous oxygen saturation ≤ 93% [89/279 (31.9%)] or peak body temperature ≥ 38.5 °C [185/301 (61.5%)] on admission. Liver injury-related inflammations included increased white blood cells, neutrophils and decreased lymphocytes. More patients with liver injury than without had increased serum IL-2R, TNFα, ferritin, hsCRP, PCT, ESR, γ-GT, and LDH. Multivariate regression analysis revealed that increasing odds of liver injury were related to male, higher serum hsCRP (≥ 10 mg/L), and neutrophil-to-lymphocyte ratio (NLR) (≥ 5). Moreover, more deceased patients (14/82 (17%)) had significantly elevated serum TBIL than discharged patients [25/532 (4.7%)]. Conclusion Liver injury is a common complication in COVID-19 patients. The potential risk factors of liver injury include male, hsCRP and NLR score. A close monitor of liver function should be warned in COVID-19 patients, especially in severe/critical individuals.

Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury

“…Accumulating evidence revealed a broad spectrum of proinflammatory cytokines and chemokines dramatically increased in patients with liver dysfunction compared to those with normal liver function[ 10 , 32 ]. Consistent with these results, our data showed the levels of inflammatory markers including high sensitivity CRP, neutrophil-to-lymphocyte ratio, white blood cells, neutrophils, serum ferritin, lactate dehydrogenase, procalcitonin, erythrocyte sedimentation rate and proinflammatory cytokines including IL-2R, IL-6, tumor necrosis factor-α in the liver injury group were significantly higher compared with the group without liver injury[ 51 ]. In an analysis of 85 patients with COVID-19, lymphopenia and CRP may even serve as the risk factors related to hepatic injury[ 32 ].…”

“…Accumulating data reveals that patients with pre-existing liver diseases are more susceptible to SARS-CoV-2 infection and have poorer prognosis. In our study, viral hepatitis (hepatitis B and hepatitis C) was much more frequent among patients with liver injury than those without[ 51 ]. Another study revealed that COVID-19 patients with non-alcoholic fatty liver disease had a significantly higher likelihood of abnormal liver function from admission to discharge when compared to those with non-alcoholic fatty liver disease subjects[ 52 ].…”

Liver injury in the era of COVID-19

“…Wang et al [ 69 ] concluded after studying 657 patients infected with SARS-CoV-2 in Wuhan that not only male sex, but also serum concentration of high sensitivity CRP ≥ 10 mg/L and a neutrophil-to-lymphocyte ratio ≥ 5 predispose to liver injury during the course of COVID-19, defined in this survey as a serum level of ALT or total bilirubin greater than the ULN. Thus, an inflammatory background may be closely related to liver function impairment as a complication of the disease[ 70 , 71 ].…”

Hepatic Failure in COVID-19: Is Iron Overload the Dangerous Trigger?

“…Derangement of ALT/AST levels represents the main indication of liver damage in COVID-19, accompanied by slightly elevated bilirubin levels. The incidence of hepatic injury ranges from 14.8% to 53%, but in severe COVID-19 patients the incidence of liver injury may increase to 58–78% [ 5 , 6 ]. Different mechanisms have been proposed that may be responsible for hepatic injury: SARS-CoV-2 direct damage on hepatocytes and biliary epithelium, or indirect damage induced by exaggerated cytokines storm, and/or drug-induced hepatoxicity.…”