COVID-19: Abnormal liver function tests

Cai, Qing-Qing; Huang, Deliang; Yu, Hong; Zhu, Zhibin; Zhang, Xia; Su, Yinan; Li, Zhiwei; Zhou, Guangde; Gou, Jizhou; Qu, Jiuxin; Sun, Yan; Liu, Yingxia; He, Qin; Chen, Jun; Liu, Lei; Xu, Lin

doi:10.1016/j.jhep.2020.04.006

Cited by 846 publications

(1,289 citation statements)

References 33 publications

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“…Among a variety of recent publications about COVID-19, accumulated evidence suggests that SARS-CoV-2 infections might cause multiple and systemic injuries, including acute renal failure, myocardial dysfunction, and acute liver injury 20,24,25 . Additionally, there are recent studies analyzing COVID-19 patients in detail with respect to liver enzymes, such as ALT and AST 20,26 . The underlying mechanism of elevated liver enzymes in COVID-19 patients remains unclear.…”

Section: Discussionmentioning

confidence: 99%

High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

Qin

Wei

Lyu³

et al. 2020

Preprint

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This study aimed to analyze aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in COVID-19 patients. After exclusion, 567 inpatients were included in this study and separated into two groups according to their AST/ALT ratio on admission. Poor prognosis included death and transfer to other hospitals due to deterioration. Of 567 patients, 56 (9.9%) had AST/ALT ≥ 2. Of the 56 patients, older age (median age 65.5 years), fatigue (29 [51.8%] cases), comorbidities (33 [58.9%] cases) and outcomes were significantly different from patients with AST/ALT < 2. They also had worse chest computed tomography (CT) findings, laboratory results and severity scores. Levels of platelet count (OR = 0.989, 95% CI [0.983-0.996]) were independently associated with AST/ALT ≥ 2 on admission. Furthermore, a high AST/ALT ratio on admission was an independent risk factor for poor prognosis (OR = 22.02, 95% CI [1.84-263.2]), especially in patients with AST levels > 40 U/L. In subsequent monitoring, the AST/ALT ratio was decreased in both patients with AST/ALT < 2 or ≥ 2 on admission. COVID-19 patients who are older, or have fatigue, comorbidities are more likely to have AST/ALT ≥ 2 on admission, which might be the indication of worse status and outcomes.

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Section: Discussionmentioning

confidence: 99%

High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

Qin

Wei

Lyu³

et al. 2020

Preprint

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“…The derangement of liver function tests at presentations has been reported in up to 50% of patients without liver disease [21]. The exact signi cance of the rise in transaminases and its relation to outcomes is unclear.…”

Section: Discussionmentioning

confidence: 99%

Poor Outcomes in Patients with Cirrhosis and COVID-19

Shalimar

Elhence

Vaishnav

et al. 2020

Preprint

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Abstract Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease 2019(COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure(ACLF) were included. The etiology of cirrhosis was alcohol(n=9), non-alcoholic fatty liver disease(n=2), viral(n=5), autoimmune hepatitis(n=4), and cryptogenic cirrhosis(n=6). The clinical presentations included complications of cirrhosis in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

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“…Some studied showed that about majority of COVID-19 patients had received nonsteroidal anti-in ammatory drugs, antibiotics and antiviral agents (e.g., acetaminophen, moxi oxacin, oseltamivir, arbidol, lopinavir/ritonavir, etc), all of above drugs had explicit liver injury effect, such as type 2 and type 4, however, it is even di cult to evaluate exact liver damage particularly in combination therapy. 2,3,11,12,14,22 Fourth, underlying of chronic liver disease. Guan et al found that non-severe patients with COVID-19, even though they have basic liver diseases (such as viral hepatitis, etc.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Studies have con rmed that SARS-CoV-2 enters cells primarily through angiotensin converting enzyme2 (ACE2), the high expression of ACE2 in alveolar type II cells makes the lung become the main target organ. 9,10 A number of existing clinical studies showed that some patients with COVID-19 had different degrees of liver dysfunction [11][12][13][14][15][16] and the liver biopsy from a dead COVID-19 case showed moderate microvascular steatosis and mild lobular activity in addition to severe lung injury. 17 The objective of this retrospective study was to explored the pattern of liver dysfunction, risk factors and outcomes in patients with COVID-19, so as to provide reference for clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

The Pattern of Liver Dysfunction in Patients with COVID-19: A Retrospective Study

wang¹,

Rong²,

Wei³

et al. 2020

Preprint

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Background. Information about liver dysfunction in patients with COVID-19 is scarce. We aimed to explored the pattern and risk factors of liver dysfunction in patients with COVID-19.Methods. In this retrospective study, we included all consecutive confirmed patients with COVID-19 in Fuyang Second People’s Hospital between January 20 and February 25, 2020 and collected clinical characteristics until discharge. The pattern and risk factors of liver dysfunction, viral shedding and outcome were analyzed.Results. Totally, 146 patients were analyzed. The median age was 44.9 years and 54.1% were men, 43.8% patients presented liver dysfunction (22.6% on admission, 21.2% during hospitalization). The percentage of elevated ALT (15.1% on admission and 24.7% during hospitalization) were significantly higher than ALP (2.1% on admission and 3.4% during hospitalization) (P < 0.001). Four clinical types were identified, type 1 (persistent normal liver function, 56.2%), type 2 (normal liver function on admission developed to liver dysfunction during hospitalization, 21.2%), type 3 (liver dysfunction on admission restored to normal on discharge, 13.0%) and type 4 (persistent liver dysfunction, 9.6%). The median duration of viral shedding was 12.0 (type 1), 15.0 (type 2), 14.0 (type 3) and 18.0 (type 4) days (P < 0.001). Prolonged viral shedding and severity were potential risk factors associated with liver dysfunction. Conclusions. The incidence of liver dysfunction in patients with COVID-19 is common but not severe, which mainly due to SARS-CoV-2-mediated immune injury on hepatocyte rather than cholangiocyte, DILI and underlying chronic liver disease should not be neglect.

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COVID-19: Abnormal liver function tests

Abstract: Abnormal liver function tests in patients with COVID-19Liver injury associated with use of drugs in patients with COVID-19

Cited by 846 publications

References 33 publications

High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

Poor Outcomes in Patients with Cirrhosis and COVID-19

The Pattern of Liver Dysfunction in Patients with COVID-19: A Retrospective Study

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