Clinical Features of COVID-19-Related Liver Functional Abnormality

Fan, Zhichao; Chen, Liping; Li, Jun; Cheng, Xin; Yang, Jincheng; Tian, Cheng; Zhang, Yajun; Huang, Shaoping; Liu, Zhanju; Cheng, Jun

doi:10.1016/j.cgh.2020.04.002

Cited by 719 publications

(768 citation statements)

References 21 publications

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“…(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. those of previous studies, which have shown associations between older age, male sex, unmediated inflammatory response to infection, and lymphopenia with increased risks of AICU admission for severe complications (18,20,21).…”

Section: Discussionmentioning

confidence: 48%

Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom

Fletcher¹,

Matcham²,

Tibúrcio³

et al. 2020

Preprint

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Background The novel coronavirus disease 2019 outbreak presents a significant threat to global health. A better understanding of patient clinical profiles is essential to drive efficient and timely health service strategies. In this study, we aimed to identify risk factors for a higher susceptibility to symptomatic presentation with COVID-19 and a transition to severe disease. Methods We analysed data on 2756 patients admitted to Chelsea & Westminster Hospital NHS Foundation Trust between 1 st January and 23rd April 2020. We compared differences in characteristics between patients designated positive for COVID-19 and patients designated negative on hospitalisation and derived a multivariable logistic regression model to identify risk factors for predicting risk of symptomatic COVID-19. For patients with COVID-19, we used univariable and multivariable logistic regression to identify risk factors associated with progression to severe disease defined by: 1) admission to the hospital's AICU, 2) the need for mechanical ventilation, 3) in-hospital mortality, and 4) at least one measurement of elevated Ddimer (≥1,000 μg/L) indicative of increased risk of venous thromboembolism. Results The patient population consisted of 1148 COVID-19 positive and 1608 COVID-19 negative patients. Age, sex, self-reported ethnicity, C-reactive protein, white blood cell count, respiratory rate, body temperature, and systolic blood pressure formed the most parsimonious model for predicting risk of symptomatic COVID-19 at hospital admission. Among 1148 patients with COVID-19, 116 (10.1%) were admitted to the AICU, 71 (6.2%) required mechanical ventilation, 368 (32.1%) had at least one record of D-dimer levels ≥1,000 μg/L, and 118 patients died. In the multivariable logistic regression, age (OR = 0.953 per 1 year, 95% CI: 0.937-0.968) C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.007), and white blood cell counts (OR = 1.059 per 10 9 /L, 95% CI: 1.010-1.111) were found to be associated with admission to the AICU. Age (OR = 0.973 per 1 year, 95% CI: 0.955-0.990), C-reactive protein (OR = 1.003 per 1 mg/L, 95% CI: 1.000-1.006) and sodium (OR = 0.915 per 1 mmol/L, 0.868-0.962) were associated with mechanical ventilation. Age (OR = 1.023 per 1 year, 95% CI: 1.004-1.043), CRP (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.006), and body temperature (OR = 0.723 per 1 o C, 95% CI: 0.541-0.958) were associated with elevated D-dimer. For mortality, we observed associations with age (OR = 1.060 per 1 year, 95% CI: 1.040-1.082), female sex (OR = 0.442, 95% CI: 0.442, 95% CI: 0.245-0.777), Asian ethnic background (OR All rights reserved. No reuse allowed without permission. : medRxiv preprint = 2.237 vs White ethnic background, 95% CI: 1.111-4.510), C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.001-1.006), sodium (OR = 1.038 per 1 mmol/L, 95% CI: 1.001-1.006), and respiratory rate (OR = 1.054 per 1 breath/min, 95% CI: 1.024-1.087). Conclusion Our analysis suggests there are several demographic, clinical and laboratory findings associated ...

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Section: Discussionmentioning

confidence: 48%

Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom

Fletcher¹,

Matcham²,

Tibúrcio³

et al. 2020

Preprint

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“…33,36 Liver injury may occur after the use of multiple drugs, such as antivirals, antibiotics, traditional Chinese medicine, antipyretics and analgesics. 7,10 Although liver histology is poorly accessible in COVID-19, few studies have already reported pathological findings on autopsies performed on SARS-CoV-2 infected patients. Xu et al observed microvesicular steatosis and mild lobular and portal activity.…”

Section: Covid -19 and Hepati C Inj Urymentioning

confidence: 99%

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

Garrido

Liberal

Macedo

2020

Aliment Pharmacol Ther

165

187

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SummaryBackgroundSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the causative pathogen of coronavirus disease 2019 (COVID‐19), became a global threat to human health. Liver impairment has been frequently reported as a common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver disease (CLD).AimsTo summarise the changes in liver function tests during SARS‐CoV‐2 infection and the impact of COVID‐19 in patients with underlying CLD.MethodsA literature review using online database PubMed was done using the search terms “SARS‐CoV‐2”, “COVID‐19”, “liver”, “cirrhosis” and “liver transplantation”.ResultsCOVID‐19 is frequently associated with different degrees of abnormal liver function tests, most notably transaminases, which are usually transitory and of mild degree. Available evidence suggests that liver injury may result from direct pathogenic effect by the virus, systemic inflammation or toxicity from commonly used drugs in this subset of patients. SARS‐CoV‐2 infection in children is associated with minimal or no increase in liver enzymes, thus the presence of abnormal liver function tests should trigger evaluation for underlying liver diseases. Although it seems that patients with CLD are not at greater risk for acquiring the infection, those with cirrhosis, hepatocellular carcinoma, non‐alcoholic fatty liver disease, autoimmune liver diseases or liver transplant may have a greater risk for severe COVID‐19.ConclusionsAbnormal liver function tests during the course of COVID‐19 are common, though clinically significant liver injury is rare. Further research is needed focusing on the effect of existing liver‐related comorbidities on treatment and outcome of COVID‐19.

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“…All rights reserved Coronavirus disease 2019 (COVID-19) leads to elevated liver biochemistries in 15% to 53% of patients. (1)(2)(3)(4)(5)(6)(7) The profile of admission biochemistries is most frequently an aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation, with alkaline phosphatase or total bilirubin elevations more rarely reported. (8) Severe cases of COVID-19 have higher liver biochemistries on admission.…”

mentioning

confidence: 99%

Liver Biochemistries in Hospitalized Patients With COVID‐19

et al. 2020

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Background and Aims Coronavirus disease 2019 (COVID‐19) leads to elevated liver biochemistries in approximately half of patients on presentation. To date, data are limited regarding the trend of liver biochemistries over the course of illness. We aimed to evaluate the trend, etiology, and outcomes associated with liver biochemistries in COVID‐19. Approach and Results A total of 60 patients with COVID‐19 were admitted between March 21 and March 28, 2020. The mean age was 57 years, 65% were male, and 28% were Hispanic. At the study conclusion, 6 patients were deceased, 28 were discharged, and 26 remained admitted. Patients who remained admitted were followed for a median of 12 days. Of 60 patients, 41 (69%) had at least one abnormal liver biochemistry on admission. Median aspartate aminotransferase (AST) was higher than alanine aminotransferase (ALT) at admission (46 vs. 30 U/L) and during the hospital course. Aminotransferases rose above normal in 54 (93%) patients, whereas alkaline phosphatase and total bilirubin elevations were rare. Ten (17%) patients developed aminotransferases more than 5 times the upper limit of normal. AST highly correlated with ALT throughout the illness course (r = 0.97; P < 0.0001), whereas correlations with markers of muscle injury and inflammation were weak. Statin use was common before (40%) and during admission (80%) at our center, with no difference in peak liver biochemistries between users and nonusers. No demographic or comorbid illness was associated with liver injury. Admission AST (69 vs. 49; P < 0.05), peak AST (364 vs. 77; P = 0.003), and peak ALT (220 vs. 52; P = 0.002) were higher in intubated patients. Conclusions AST‐dominant aminotransferase elevation is common in COVID‐19, mirrors disease severity, and appears to reflect true hepatic injury.

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Clinical Features of COVID-19-Related Liver Functional Abnormality

Cited by 719 publications

References 21 publications

Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom

Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

Liver Biochemistries in Hospitalized Patients With COVID‐19

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