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

Abstract

Summary Background The outbreak of coronavirus disease 2019 (COVID‐19) is a critical challenge for public health. The effect of COVID‐19 on liver injury has not been fully established. Aims To evaluate the dynamic changes in liver function and the relationship between liver damage and prognosis in patients with COVID‐19. Methods Retrospective analysis of clinical data of 675 patients with COVID‐19 in Zhongnan Hospital of Wuhan University from January 3 to March 8, 2020. Patients were classified as having normal or abnormal liver function and liver injury. Results Of 675 patients, 253 (37.5%) had abnormal liver function during hospitalisation, and 52 (7.7%) had liver injury. The dynamic changes of ALT and AST levels were more significant in patients with liver injury and in those who died. AST >3‐fold upper limit of normal (ULN) had the highest risk of death and mechanical ventilation. Compared to patients with normal AST levels, mortality and risk of mechanical ventilation significantly increased 19.27‐fold (95% confidence interval [CI], 4.89‐75.97; P < 0.0001) and 116.72‐fold (95% CI, 31.58‐431.46; P < 0.0001), respectively, in patients with AST above 3‐fold ULN. Increased leucocytes, decreased lymphocytes and female sex were independently associated with liver injury. Conclusions The dynamic changes in liver function may have a significant correlation with the severity and prognosis of COVID‐19. Increased index of liver injury was closely related to mortality and need for mechanical ventilation. Therefore, these indicators should be closely monitored during hospitalisation.

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

“…Packer and Bangash for their interest in our recent report on the association between markers of liver injury and clinical outcomes in patients with COVID‐19 1 . They discussed the similarities 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 …”

Dynamic Changes in Liver Function Tests and Their Correlation with Illness Severity and Mortality in Patients with COVID-19: A Retrospective Cohort Study

“…In a Chinese cohort of 675 patients with COVID-19, compared to patients with normal AST levels, mortality and risk of mechanical ventilation significantly increased 19.27-fold and 116.72-fold, respectively, in patients with AST above 3-fold ULN. 21 In another Chinese cohort, Cai et al found that the presence of abnormal liver tests and liver injury were associated with the progression to severe COVID-19. 6 In a large Hong Kong cohort of 1040 COVID-19 patients, Yip et al found ALT/AST elevation and acute liver injury are independently associated with adverse clinical outcomes including admission to intensive care unit, use of invasive mechanical ventilation and/or death in COVID-19 patients.…”

Progress in the Clinical Features and Pathogenesis of Abnormal Liver Enzymes in Coronavirus Disease 2019

“…In addition, inflammatory markers, such as C-reactive protein (CRP), procalcitonin (PCT), serum ferritin (SF) and interleukin (IL)-6, have tended to show an in-crease that is more obvious in COVID-19-related liver injury patients. 5,12,14,20,[24][25][26] A study that included 417 COVID-19 cases showed that a total of 318 patients had abnormal liver enzymes, of which more than 90% showed mild (<2 ULN) at admission; patients with elevated ALT, AST, GGT, and TBIL levels exceeding 3 ULN during hospitalization accounted for 10.4%, 5.7%, 11.6%, and 2.8%, while ALP level did not increase significantly. 5 Further studies determined the dynamic changes of the patterns of liver enzymes in COVID-19-related liver injury.…”