Alteration of Liver Biomarkers in Patients with SARS-CoV-2 (COVID-19)

Figures & data

Table 1 Characteristics of Patients with COVID-19 and Characteristics of the ALT Elevated Group in Comparison to the Normal Group of Patients with COVID-19

Indicators	Normal Range	Value	Patients with Normal ALT (n=238)	Patients with Elevated ALT (More Than 47) (n=41)	P-value
Age (years)	–				0.054
Min		18	18	25
Max		94	94	88
Mean ± STDEV		58.99 ± 16.96	59.79 ± 17.06	54.29 ± 15.76
Sex	–				0.017
Male, n (%)		164 (58.78)	133 (55.88)	31 (75.61)
Female, n (%)		115 (41.22)	105 (44.12)	10 (24.39)
LDH (U/L)	140–280				0.014
Min		189	240	189
Max		3738	2016	3738
Mean ± STDEV		621.29 ± 352.86	578.37 ± 252.02	866.18 ± 642.20
CPK (U/L)	Male: 39–308				0.150
Min  Max  Mean ± STDEV	Female: 26–192	20 8124 286.90 ± 724.06	20 2240 213.46 ± 259.34	29 8124 720.20 ± 1757.48
AST (U/L)	0–31				<0.001
Min		8	8	18
Max		368	131	368
Mean ± STDEV		44.03 ± 43.36	33.47 ± 16.78	105.10 ± 82.93
ALT (U/L)	0–47				<0.001
Min		6	6	48
Max		384	47	384
Mean ± STDEV		31.14 ± 3790	21.13 ± 9.73	89.27 ± 73.22
AST/ALT ratio	<1				<0.001
Min		0.37	0.43	0.37
Max		4.29	4.29	4.12
Mean ± STDEV		1.64 ± 0.72	1.71 ± 0.69	1.25 ± 0.79
CRP	–				0.922
Negative		56 (20.07)	48 (20.17)	8 (19.51)
1+		83 (29.75)	67 (28.15)	16 (39.02)
2+		62 (22.22)	50 (21.01)	12 (29.27)
3+		55 (19.71)	52 (21.85)	3 (7.32)
4+		23 (8.24)	21 (8.82)	2 (4.88)
WBC (10^3/µL)	Male: 4–11				0.188
Min		0.70	1.10	0.7
Max		21.50	21.50	19.5
Mean ± STDEV		7.38 ± 3.96	7.25 ± 3.86	8.13 ± 4.47
RBC (10^6/µL)	Male: 4.7–6.1				0.457
Min	Female: 4.2–5.4	2.47	2.77	2.47
Max		6.29	6.20	6.29
Mean ± STDEV		4.53 ± 0.65	4.54 ± 0.60	4.46 ± 0.90
HB (g/dl)	Male: 13.5–17.5				0.956
Min	Female: 12–15.5	6.30	8.10	6.3
Max		18.30	18.30	17.1
Mean ± STDEV		13.25 ± 2.11	13.23 ± 1.95	13.37 ± 2.91
HCT (%)	Male: 45–52				0.617
Min	Female: 37–48	21.30	23.80	21.3
Max		56.10	56.10	50.9
Mean ± STDEV		39.99 ± 5.57	40.03 ± 5.20	39.74 ± 7.45
MCV (fl/cell)	80–96				0.256
Min		66	66	76
Max		105	56.10	104
Mean ± STDEV		88.58 ± 5.71	40.03 ± 5.20	89.51 ± 5.31
MCH (pg/cell)	27–33				0.163
Min		20	20	21
Max		44	35	44
Mean ± STDEV		29.33 ± 2.60	29.21 ± 2.49	30.00 ± 3.12
MCHC (g/dl)	31–37				0.446
Min		27	27	27
Max		48	37	48
Mean ± STDEV		33.10 ± 1.91	33.04 ± 1.63	33.44 ± 3.09
Platelet (10^4/µL)	15–450				0.121
Min		17	17	32
Max		694	694	329
Mean ± STDEV		176.01 ± 83.70	178.79 ± 86.58	159.88 ± 62.99
Neutrophil (%)	45–74				0.003
Min		0	0	53.9
Max		95.40	95.40	95.2
Mean ± STDEV		74.85 ± 12.82	74.04 ± 13.15	79.79 ± 9.38
Lymphocyte (%)	16–45				0.009
Min		2.80	3.10	2.8
Max		55	55	44.1
Mean ± STDEV		19.18 ± 10.21	19.86 ± 10.28	15.18 ± 8.91
Diff result mixed (%)	–				0.913
Min		0.80	0.80	1.7
Max		26.60	26.60	11.4
Mean ± STDEV		5.49 ± 3.49	5.48 ± 3.61	5.55 ± 2.86
RDW (%)	11.5–14.5				0.325
Min		11.40	11.40	11.9
Max		47.80	47.80	36.5
Mean ± STDEV		16.37 ± 6.74	16.55 ± 6.82	15.32 ± 6.24
PDW (%)	10–17.9				0.869
Min		9.10	9.10	10.4
Max		21.20	21.20	19.3
Mean ± STDEV		10.15 ± 0.99	13.31 ± 2.24	13.38 ± 2.46
MPV (fl)	9.4–12.3				0.523
Min		8	8	8.8
Max		13.10	13.10	12.5
Mean ± STDEV		10.15 ± 0.99	10.13 ± 0.99	10.26 ± 0.99
P-LCR (fl)	7.5–10.5				0.572
Min		11.20	11.20	18.4
Max		46.70	46.70	45.2
Mean ± STDEV		27.13 ± 7.37	27 ± 7.34	27.83 ± 7.61

Abbreviations: ALT, alanine aminotransferase; AST, aspartate transaminase; CPK, creatine phosphokinase; CRP, C-reactive protein; HB, hemoglobin; HCT, hematocrit; LDH, lactate dehydrogenase; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; MPV, mean platelet volume; PDW, platelet distribution width; P-LCR, platelet-large cell ratio; RBC, red blood cell; RDW, red cell distribution width; WBC, white blood cell.

Figure 1 Distribution of ALT, AST, AST/ALT ratio, and LDH values among the elevated ALT and normal ALT patients with COVID-19. Each point in the diagrams show the values of the individual patients. Orange points belong to the elevated ALT patients and blue points to the normal ALT patients. The values of ALT, AST, AST/ALT ratio, and LDH of the elevated ALT patients were increased in comparison to the normal ALT patients (P-value < 0.05).

Figure 2 Correlation of the ALT, AST, CPK and LDH values with each other in patients with normal ALT and elevated ALT. The positive correlation was shown between the ALT and AST values in patients with elevated ALT, while the positivecorrelation between all values was shown with each other in patients with normal ALT.