COVID-19 severity links to abnormality in liver function tests
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Among patients hospitalized with COVID-19, liver impairment appeared within the first days of admission; virus severity also correlated with abnormality in liver function tests.
“In terms of liver involvement [in COVID-19], liver function test (LFT) abnormalities are frequent and the most common is an increase of aspartate aminotransferase. Moreover, most of the LFT abnormalities are minor and less than 20% exceeded the upper limit of abnormality,” Lidia Canillas, Hospital del Mar in Barcelona, Spain, said. “Severe LFT abnormalities have been related to more severe infection; to our knowledge, no data about the evolution of LFTs electives and liver damage at the resolution of acute infection have been reported so far.”
In a retrospective, observational study, researchers analyzed 595 patients hospitalized with COVID-19 (mean age 62 years; 60.7% men) to evaluate factors related to LFT abnormality amid COVID-19. They determined abnormality grade (1-4) using AST, alanine aminotransferase and total bilirubin levels; additional recorded assessments included sociodemographic data, comorbidities, COVID-19 infection severity, laboratory tests, treatments and mortality. Researchers noted severe COVID-19 in 42% of patients.
Study results revealed LFT abnormality in 61.5% of patients with grade 1, 38.8% of patients with grade 2, 11.8% of patients with grade 3 and 10.3% of patients grade 4. Among patients with severe LFT, abnormality varied between mild (64.5%) and severe (35.5%) at hospital admission with the median onset of maximum LFT impairment at 12-days from hospital admission. Further multivariate analysis revealed LFT abnormality correlated with higher interleukin-6 (1.63; 1.01-2.62) and ferritin (2.68; 1.64-4.37); worsened LFTs during hospital admission correlated with ICU admission (5.34; 3.08-9.28) and use of immunomodulatory drugs (2.57; 1.5-4.39). Mortality within this cohort was 10.7%.
“The presence of abnormal LFTs at follow-up was not related to abnormal LFTs during COVID-19 hospital admission,” Canillas concluded. “Patients with altered LFTs at follow-up have an underlying cause, most of them fatty liver disease.”