Liver damage at admission is an independent prognostic factor for COVID‐19

Abstract

Objective Abnormal liver function is a common form of extra‐pulmonary organ damage in patients with coronavirus disease 2019 (COVID‐19). Patients with severe COVID‐19 have a higher probability and progression of liver injury than those without severe disease. We aimed to evaluate the prognosis of liver injury in patients with COVID‐19. Methods We retrospectively included 502 patients with laboratory‐confirmed SARS‐CoV‐2 infection. Clinical features and survival of patients with and without liver injury were compared. Cox proportional hazards models were used to determine the variables that might have an effect on survival. Results Among the 502 patients enrolled, 301 patients had abnormal liver function with increased neutrophil count, C‐reactive protein, creatinine, troponin I (TnI), D‐dimer, lactose dehydrogenase and creatine kinase. Patients with abnormal liver functions had a higher mortality rate (28.9% vs 9.0%, P < 0.001), a higher ratio of male sex (65.1% vs 40.8%, P < 0.001) and a higher chance of developing systemic inflammatory response syndrome (53.5% vs 41.3%, P = 0.007). Among patients with abnormal liver functions, patients with grade 2 liver damage (with both abnormal alanine aminotransferase or aspartate aminotransferase levels and abnormal alkaline phosphatase or gamma‐glutamyl transpeptidase levels) had a higher ratio of male patients, elevated neutrophil count, procalcitonin, D‐dimer levels and mortality rate. Multivariate Cox regression analyses suggested that the grade of liver damage (hazard ratio: 1.377, 95% confidence interval: 1.000‐1.896, P = 0.049) was an independent predictor of death. Conclusions Patients with COVID‐19 and abnormal liver functions have a higher mortality than those with normal liver functions. Liver damage is an independent prognostic factor of COVID‐19.

Liver Fibrosis Index FIB‐4 Is Associated With Mortality in COVID‐19

“…( 14 ) This trivial difference makes AST alone less ideal to predict COVID‐19 outcomes. In contrast, FIB‐4 includes AST and age as numerators, which are positively correlated to liver fibrosis ( 6,10,15 ) ; it also reflects the AST dominant pattern in COVID‐19 reported by earlier studies, ( 4,16 ) as well as age, which has been shown since early in this pandemic to be one of the strongest indicators of adverse outcomes, including death. ( 2 ) These features make the FIB‐4 score a better predictor compared with any of its components alone.…”

Severe acute respiratory syndrome coronavirus‐2 infection and the gut–liver axis

“…Other important pathological features observed include hepatic necrosis and mild portal and lobular lymphocytic infiltration, 48,53,54 with no concrete evidence of liver injury 18 . Liver biopsies taken from 48 fatal cases of SARS‐CoV‐2 infection revealed major vascular alterations with minimal hepatic inflammation 55 . Some cases also exhibited fibrosis of the portal tract 55 .…”

“…Liver biopsies taken from 48 fatal cases of SARS‐CoV‐2 infection revealed major vascular alterations with minimal hepatic inflammation 55 . Some cases also exhibited fibrosis of the portal tract 55 . It is likely that the liver does not undergo significant inflammatory damage during SARS‐CoV‐2 infection, and the hepato‐vascular alterations observed are a secondary response to systemic changes induced by SARS‐CoV‐2.…”

“…Several studies have shown that alterations in transaminase levels in systemic coronaviral infections are transient, and hence may reflect the level of circulating cytokines and the status of immune activation 79 . Considering that histopathological analyses did not identify significant inflammatory damage to the liver, 53,55 it is plausible that liver enzyme alterations in patients infected with SARS‐CoV‐2 are due to bystander hepatitis, which occurs as a secondary response to systemic inflammation by SARS‐CoV‐2.…”

SARS-CoV-2 Virus Manifestations in the Gastrointestinal Tract: Therapeutic Implications

“…Cai et al [44] showed that 76.3% of COVID-19 patients present with liver injury and 21.5% show liver damage in a study with 417 patients. A study by Chen et al [45] involving 502 COV­ID-19 patients revealed that liver abnormalities represent an indicator of severe disease, including higher rates of systemic inflammatory response syndrome and death.…”