Liver Biochemistries in Hospitalized Patients With COVID‐19

Abstract

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.

The association between markers of liver injury and clinical outcomes in patients with COVID‐19 in Wuhan

“…This suggested that liver injury was the predominant source of aminotransferase elevation. 17 It is in agreement with our findings.…”

“…In this study, we retrospectively and systematically analysed the There were few studies on the dynamic changes of liver functions in COVID-19-related liver injury. 13,17 One study had suggested that the dynamic changes in liver enzyme levels in severe patients were more significant, and AST was the parameter most correlated with mortality. 13 Another study indicated that the pattern of liver biochemical was consistent with the damage of hepatocytes, especially AST.…”

“…There were few studies on the dynamic changes of liver functions in COVID-19-related liver injury. 13,17 Nevertheless, the dy- According to the diagnosis and treatment standard of COVID-19 18 issued by the National Health Committee, the disease severity was divided into three groups: mild, severe and critical. Patients with mild type might have fever and respiratory symptoms, and pneumonia was revealed by imaging.…”

Liver involvement is not associated with mortality: results from a large cohort of SARS‐CoV‐2‐positive patients

“…We found a 31.3% prevalence of liver test abnormalities in patients with SARS-CoV-2 infection, which was slightly lower than reported in previous Western 2,3 and Chinese studies . 4 Pure cholestatic alterations characterised by the increase of both ALP and GGT were extremely rare, whereas GGT elevation was present in 13.6%…”

“…Chinese data on patients with SARS-CoV-2 infection report a prevalence of abnormal liver test as high as 76.3%, while the prevalence in Western patients seems to be lower. [1][2][3][4] However, these studies report baseline or short-term follow-up evaluations. Therefore, the evolution of liver involvement, its correlation with patients' mortality or resolution of SARS-CoV-2 infection is still unknown.…”