Liver injury at admission and outcomes in patients with COVID-19 disease: a prospective cohort study

Abstract

Background: The liver is one of the common extrapulmonary organs involved in the coronavirus disease 2019 (COVID-19) infection. We aimed to find the prevalence of liver injury at hospital admission and its effects on outcomes. Methods: This is a single-center prospective observational study. All consecutive patients with COVID-19 admitted during the months of May to August 2021 were included in the study. Liver injury was defined as at least 2 times elevation of aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin above the upper limits on normal. The predictive efficacy of liver injury was measured as its effects on outcome variables, that is duration of hospital stay, requirement of ICU admission, mechanical ventilation, and mortality. Presence of liver injury compared with existing biomarkers markers of severe disease, that is lactate dehydrogenase, D-dimer, and C-reactive protein. Results: A total of 245 consecutive adult patients with COVID-19 infection were included in the study. Liver injury was present in 102 (41.63%) of patients. There was a significant association between the presence of liver injury and duration of hospital stay (10.74 vs. 8.9 days; P=0.013), the requirement of ICU admission (12.7 vs. 10.2%; P=0.018), mechanical ventilation (10.6% vs. 6.5%; P=0.003), and mortality (13.1% vs. 6.1%; P<0.001). Liver injury was significantly associated (P<0.001) with the corresponding elevation of serum biomarkers of severity. Conclusion: The presence of liver injury in patients with COVID-19 infection at the time of hospital admission is the independent predictor of poor outcomes and can also be used as the marker of disease severity.

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…Significantly greater risk of hepatic complications in men is usually explained by more pronounced liver steatosis and alcohol intake. Previous observations revealed that enzymatic features of liver disorder accompanying COVID-19 might predict a more severe course of the disease, poorer overall outcome and a higher rate of mortality [151][152][153][154][155]. In general, individuals affected with SARS-CoV-2 infection usually present a hepatocellular pattern of liver injury (with a threefold increase in aminotransferases above the upper limit of normal (ULN)) or a mixed one (hepatocellular pattern together with a twofold increase in ALP/GGT) [156].…”