Clinical Course and Risk Factors for Liver Injury of Severe and Critical Patients with COVID-19

Abstract

Introduction

Information regarding the clinical course of COVID-19 patients with liver injury is very limited, especially in severe and critical patients. The objective of this study was to describe the characteristics and clinical course of liver function in patients admitted with severe and/or critical SARS-CoV-2 infection, as well as explore the risk factors that affect liver function in the enrolled COVID-19 patients.

Methods

Information on clinical characteristics of 63 severe and critical patients with confirmed COVID-19 was collected. Data on patients’ demographics, laboratory characteristics, laboratory examination, SARS-CoV-2 RNA results and liver test parameters were acquired and analyzed.

Results

The incidence of abnormal aspartate aminotransferase, alanine aminotransferase, and total bilirubin in the critical group was significantly higher than in the severe group (respectively 81.48%, 81.49%, 62.67%, and 45.71%, 63.88%, 22.86%, p < 0.05). The time for liver function parameters to reach their extremes was approximately 2–3 weeks after admission. The independent factors associated with liver injury were patients with invasive ventilators, decreased percentages of neutrophils, lymphocytes and monocytes, and sequential organ failure assessment (SOFA) score ≥2 (p < 0.05).

Conclusion

Abnormal liver tests are commonly observed in severe and critical patients with COVID-19. Severe patients infected by SARS-CoV-2 should be closely observed and monitored the liver function parameters, particularly when they present with independent risk factors for liver injury.

Keywords:

• abnormal liver tests
• coronavirus disease 2019
• COVID-19
• liver injury
• pneumonia
• severe acute respiratory syndrome coronavirus 2
• SARS-CoV-2

Abbreviations

ARDS, acute respiratory distress syndrome; ALT, alanine aminotransferase; AST, aspartate aminotransferase; A/G, albumin/globulin; BUN, blood urea nitrogen; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; Ct, cycle threshold; ECMO, extracorporeal membrane oxygenation; INR, international normalized ratio; LDH, lactate dehydrogenase; NLR, neutrophil-to-lymphocyte ratio; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SOFA, Sequential Organ Failure Assessment; TBIL, total bilirubin.

Data Sharing Statement

Data of this study can be available upon request from the author.

Ethics Approval and Consent to Participate

This clinical study was conducted in compliance with the ethical principles of the Declaration of Helsinki and its later amendments. The Ethics Committee of Beijing Ditan Hospital approved our study protocol [approval No. NA2018(005)-01]. As a de-identified retrospective study, the ethics committee did not require us to obtain written or verbal informed consent from participants.

Acknowledgments

The authors gratefully acknowledge Gang Wan Ph.D. and Jun-nan Li Ph.D. for their assistance with data analysis. Thanks to all the front-line medical staff of Beijing Ditan hospital for their bravery and efforts in SARS-CoV-2 prevention and control.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas. All authors took part in drafting, revising or critically reviewing the article. All authors gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This work was supported by the Beijing Municipal Science and Technology Commission, China (Z201100005420012) and the Beijing Traditional Chinese Medicine Development Funding of Science and Technology (YJ2020-01).