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

Abstract

Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is frequently associated with liver test abnormalities. Aims To describe the evolution of liver involvement during SARS‐CoV‐2 infection and its effect on clinical course and mortality. Methods Data of 515 SARS‐CoV‐2‐positive patients were collected at baseline and during follow‐up, last evaluation or death. Stratification based on need for hospitalisation, severe disease and admission to intensive care unit (ICU) was performed. The association between liver test abnormalities (baseline and peak values) and ICU admission or death was also explored. Results Liver test abnormalities were found in 161 (31.3%) patients. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) were increased in 20.4%, 19% and 13.6% of patients, respectively. Baseline liver test abnormalities were associated with increased risk of ICU admission (OR 2.19 [95% CI 1.24‐3.89], P = 0.007) but not with mortality (OR 0.84 [95% CI 0.49‐1.41], P = 0.51). Alkaline phosphatase (ALP) peak values were correlated with risk of death (OR 1.007 [95% CI 1.002‐1.01], P = 0.005) along with age, multiple comorbidities, acute respiratory distress syndrome, ICU admission and C‐reactive protein. Alterations of liver tests worsened within 15 days of hospitalisation; however, in patients with the longest median follow‐up, the prevalence of liver test alterations decreased over time, returning to around baseline levels. Conclusions In SARS‐CoV‐2‐positive patients without pre‐existing severe chronic liver disease, baseline liver test abnormalities are associated with the risk of ICU admission and tend to normalise over time. The ALP peak value may be predictive of a worse prognosis.

A narrative review on characterization of acute respiratory distress syndrome in COVID-19-infected lungs using artificial intelligence

“…These comorbidities play a vital role in segregating AI models that can be independently trained for effective diagnosis and COVID-19 severity prediction. The selected comorbidity studies [ 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 ] were taken from https://pubmed.ncbi.nlm.nih.gov/ . Figure 5 shows the number of subjects with comorbidities enrolled in the ARDS-based studies.…”

Hepatic manifestations of COVID-19

“…6,9 Other abnormalities in liver enzymes include elevations in gamma-glutamyl transferase (GGT), which, in one study, occurred in 13.6% of patients with COVID-19. 10…”

“…6 Furthermore, an Italian retrospective study of 515 SARS-CoV-2 positive patients found that abnormal baseline liver enzyme levels were associated with an increased risk of ICU admission. 10 Finally, a recently published meta-analysis of 107 studies found that patients with elevated liver enzyme levels had an increased risk of severe disease and mortality. 3 Specific patterns of liver enzymes have also been shown to be negative prognostic markers.…”

Editorial: intended victim or innocent bystander? The liver in COVID‐19—Authors' reply

“…Shanshan Chen 1,2 Hong Li 1,3 Xian-Long Zhou 4,5 Yining Dai 1 TA B L E 1 Characteristics of COVID-19 patients with and without lopinavir/ ritonavir treatment…”

“…ilarities and differences between our findings and those of another study from Italy, and provided insights into the possible causal relationship between liver enzyme marker abnormalities and COVID-19. 2,3 Several studies have reported that liver injury was associated with the severity of COVID-19. 4,5 Until now, the mechanism of liver injury has been controversial.…”