Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

Abstract

Globally, over the past several months millions of persons contracted the coronavirus disease 2019 (COVID-19) resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as AST, ALT, GGT and ALP are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.

Remdesivir use and risks of acute kidney injury and acute liver injury among patients hospitalised with COVID‐19: a self‐controlled case series study

“…A similar finding was reported when comparing remdesivir with other treatments of COVID‐19: serum AST and ALT levels were significantly higher in the remdesivir group and the risk of hepatic impairment increased 46,47 . Some case studies suggested causality of hepatotoxicity as AST and ALT levels were elevated or peaked immediately after the initiation of remdesivir, but the situation ameliorated afterwards 22,48,49 . In addition, the disproportionately high reporting of aminotransferase elevation compared with other COVID‐19 treatment options suggested drug‐induced liver injury 50 …”

“…46,47 Some case studies suggested causality of hepatotoxicity as AST and ALT levels were elevated or peaked immediately after the initiation of remdesivir, but the situation ameliorated afterwards. 22,48,49 In addition, the disproportionately high reporting of aminotransferase elevation compared with other COVID-19 treatment options suggested drug-induced liver injury. 50 Nonetheless, some studies did not associate remdesivir with liver injury as the difference of clinical measurements was insignificant between treatment and placebo groups.…”

Características del SARS-CoV-2, COVID-19 y su diagnóstico en el laboratorio

“…Sin embargo, como se mencionó anteriormente, no está claro si el daño o disfunción hepática están relacionados con la infección viral directa o si es consecuencia del uso de fármacos potencialmente hepatotóxicos o parte de la disfunción multiorgánica [59]. La gamma glutamil transferasa (GGT), un biomarcador de diagnóstico para la lesión de los colangiocitos, también se ha informado que aumenta en los estudios de casos existentes de COVID-19 [61].…”

Long‐term side effects and lingering symptoms post COVID‐19 recovery

“…34 1.1.4 | Long-term effects on the liver during the path to recovery Elevated liver function tests have been reported with abnormal levels of aspartate aminotransferases (AST) and alanine aminotransferase (ALT). 36 Liver injury can also be related to drugs. Most patients with COVID-19 show mild liver damage and return to normal, targetted hepatoprotective therapy is necessary in patients with severe liver injury.…”

“…Elevated liver function tests have been reported with abnormal levels of aspartate aminotransferases (AST) and alanine aminotransferase (ALT) 36 . Liver injury can also be related to drugs.…”