A High Percentage of Patients Recovered From COVID-19 but Discharged With Abnormal Liver Function Tests

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) pandemic has become the most severe global health issue. Abnormal liver functions are frequently reported in these patients. However, liver function abnormality was often overlooked during COVID-19 treatment, and data regarding liver functions after cure of COVID-19 is limited. This study aimed to reveal the changes of liver function tests (LFTs) during hospitalization, and its clinical significance in patients with COVID-19.MethodsIn this retrospective, bi-center study, a total of 158 hospitalized patients diagnosed with COVID-19 in China were included from January 22nd, 2020 to February 20th, 2020. Clinical features, laboratory parameters including LFTs, and treatment data were collected and analyzed. LFTs included alanine transaminase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and total bilirubin. Patients were considered with abnormal LFTs when any value of these tests was higher than upper limit of normal.ResultsOf 158 patients with COVID-19, 67 (42.41%) patients had abnormal LFTs on admission and another 50 (31.65%) patients developed abnormal LFTs during hospitalization. The incidence of LFTs abnormality in severe COVID-19 cases was significantly higher than non-severe cases. All LFTs in COVID-19 patients were correlated with oxygenation index. There was no statistical difference in treatment between the patients with or without liver test abnormalities. By the time of discharge, there were still 64 (40.50%) patients with abnormal LFTs. Logistic regression analysis identified younger age, hypertension and low lymphocyte counts as independent risk factors for persistent abnormal LFTs during hospitalization.ConclusionLiver function tests abnormality was common in COVID-19 patients and was more prevalent in severe cases than in non-severe cases. A substantial percentage of patients still had abnormal LFTs by the time of discharge.

Abnormal Liver Tests during Hospitalization Predict Mortality in Patients with COVID-19: A Multicenter Study from South America

“…Moreover, similar to other studies, no differences were observed between patients with or without abnormal LFT related to medications that were indicated prior to admission [20]. Finally, as was suggested by other authors, it is possible that patients with ALEx2 might present a higher percentage of undiagnosed chronic liver disease [10]. Prior studies showed that patients with underlying liver disease have a higher percentage of liver test abnormalities and decompensated cirrhosis, which were associated with severe COVID-19 [18,26].…”

“…On the other hand, cholangiocytes express high levels of ACE2 and could be the target of SARS-CoV-2 in the liver. Nevertheless, ALP was not usually as elevated in our or other studies as it might be expected [ 10 , 24 ]. A proposed mechanism that has gained popularity based on preliminary data includes the cytokine storm associated with systemic inflammatory response syndrome, especially in patients with severe COVID-19 infection [ 19 , 25 ].…”

“…During their hospital stay, 137 (46%) patients were transferred to the ICU, with 65 (21.8%) requiring vasopressors. A total of 99 (33%) patients required mechanical ventilation, with a median length on mechanical ventilation of 14 days (IQR [8][9][10][11][12][13][14][15][16][17][18][19]. e median length of ICU admission was 13 days (IQR 6-20.8) and the median global length of hospitalization was 13 days (IQR 7-22).…”

“…In cases of severe COVID-19, the incidence of liver injury can reach 93%, indicating a possible association between COVID-19-related liver disease and mortality [ 9 ]. However, there is little information available related to modifications of liver function tests (LFT) during hospitalization and their role as a marker of severity in patients with severe COVID-19 [ 10 ].…”

Comparison of the clinical and radiological manifestations of male patients with COVID‐19 from different ethnicities

“… 13 In addition, many studies have highlighted the correlation of abnormal liver functions with severe COVID‐19 disease. 14 , 15 , 16 , 17 , 18 In this report, COVID‐19 was mainly studied in male patients. This could be attributed to the nature of the kingdom, in which the primary workers are male.…”