Dynamic Changes of Liver Function Indexes in Patients with Different Clinical Types of COVID-19

Abstract

Background To investigate the liver function indexes and dynamic changes in patients with different clinical types of new coronavirus pneumonia (COVID-19). Methods A retrospective analysis of 170 COVID-19 patients hospitalized in the Wuxi Fifth People’s Hospital was divided into asymptomatic group (13 cases), mild-common group (142 cases) and seriously-critically ill group (15 cases), the clinical data and liver function indexes of the three groups were compared. Results A total of 170 patients included 94 males and 76 females, with an average age of 44.7 ± 17.8 years. Seriously-critically ill group was older, and the proportion of patients with diabetes and liver injury at admission was also higher. As the hospitalization time increased, the changes of alanine aminotransferase (ALT) levels in asymptomatic group and mild-common group were not significant (all P > 0.05), while the ALT levels of seriously-critically ill group showed a curve that first flattened and then decreased (degree of freedom: 1.809, P = 0.002). Compared with the mild-common group, the daily decrease of ALT was 1.220U/L more in the seriously-critically ill group (P<0.001). The aspartate aminotransferase (AST) in asymptomatic group and seriously-critically ill group did not decrease significantly (all P > 0.05), while the AST in mild-common group decreased significantly (regression coefficient: −10.507, P = 0.008). There was no significant difference in AST changes between the three groups (P = 0.250–0.904). Conclusion Liver injury is common in COVID-19 patients, especially for severe patients; the dynamic change pattern of liver function indicators may be helpful to judge liver injury and evaluate treatment effects in patients with different clinical types.

Liver injury associated with the severity of COVID-19: A meta-analysis

“…A total of 4,473 records were identified using the described search strategy (3,891 from PubMed, 122 from Cochrane Library, 449 from EMBASE, and 11 from other sources). After a detailed assessment based on the inclusion criteria, a total of 46 studies ( 1 – 3 , 5 , 6 , 16 – 56 ) with 28,663 patients (6,310 in the severe group and 22,353 in the non-severe group) diagnosed with COVID-19 were included in the meta-analysis ( Figure 1 ). The median age of the subjects ranged from 43 to 69 years old.…”

“…Liver injury was defined as an elevated transaminase level >3 times the upper limit of normal. Sixteen studies ( 2 , 17 , 20 , 22 – 25 , 30 , 32 , 39 , 42 – 44 , 46 , 55 , 56 ), including 6,041 COVID-19-positive patients, reported the incidence of liver injury. The pooled OR of liver injury was higher in severe COVID-19 patients, with high heterogeneity (OR = 3.25, 95% CI: 2.19–4.84, I 2 = 82.3%, P Heterogenity = 0.000) ( Figure 2A , Supplementary Table 3 ).…”

“…Seventeen studies ( 1 , 3 , 5 , 16 , 17 , 19 , 28 – 30 , 33 , 35 , 36 , 45 , 50 , 52 , 55 , 56 ), including 12,138 COVID-19-positive patients, reported the proportion of patients with CLD. The pooled proportion of patients with CLD at baseline was higher in severe COVID-19 cases, with low heterogeneity (OR = 1.38, 95% CI: 1.08–1.77, I 2 = 10.7%, P Heterogenity = 0.329) ( Figure 2B , Supplementary Table 3 ).…”

“…Thirty-five studies ( 1 , 5 , 6 , 16 – 21 , 23 , 26 – 38 , 40 , 41 , 47 – 56 ) (25,596 subjects) reported outcome data on ALT. More COVID-19 patients had severe disease than non-severe disease, and the pooled WMD was higher than the mean levels of ALT [(WMD: 12.87U/L; 95% CI: 10.52–15.23); I 2 = 99.2%, P Heterogenity = 0.000] ( Figure 3A , Supplementary Table 3 ).…”

“…Thirty-three studies ( 1 , 5 , 6 , 16 , 17 , 19 – 21 , 23 , 26 – 38 , 40 , 41 , 47 , 49 – 56 ) (25,384 subjects) reported outcome data on AST. The pooled WMD of AST levels was higher in severe cases, with high heterogeneity (WMD = 13.98 U/L, 95% CI: 12.13–15.83, I 2 = 98.2%, P Heterogenity = 0.000) ( Figure 3B , Supplementary Table 3 ).…”