Acute liver injury and its association with death risk of patients with COVID-19: a hospital-based prospective case-cohort study

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a newly respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with multiple organ injuries. The aim of this study was to analyze SARS-CoV-2-induced acute liver injury (ALI), its association with death risk and prognosis after discharge.Methods: Three-hundred and fifty-five COVID-19 patients were recruited. Clinical data were collected from electronic medical records. ALI was evaluated and its prognosis was tracked. The association between ALI and death risk was analyzed.Results: Of 355 COVID-19 patients, 211 were common, 88 severe, and 51 critical ill cases, respectively. On admission, 223 (62.8%) patients were with hypoproteinemia, 151(42.5%) with cholestasis, and 101 (28.5%) with hepatocellular injury. As expected, ALI was more common in critical ill patients. By multivariate logistic regression, male, older age and lymphocyte reduction were three important independent risk factors predicting ALI among COVID-19 patients. Death risk analysis shows that fatality rate was higher among patients with hypoproteinemia than those without hypoproteinemia (RR=9.471, P<0.001). Moreover, fatality rate was higher among patients with cholestasis than those without cholestasis (RR=2.182, P<0.05).

The Prognostic Nutritional Index is associated with mortality of COVID‐19 patients in Wuhan, China

“…In addition to impaired respiratory function, function of other organs could also be damaged. Complications including cardiac injury, acute kidney injury, acute gastrointestinal injury, coagulopathy, and liver dysfunction are relatively common in critically ill cases 4,5 and were confirmed associated with poor outcome in COVID‐19 patients 6‐10 . These organs damage is considered resulting from the cytokine release syndrome (CRS) which plays pivotal role in the progression of COVID‐19 patients 11,12 .…”

Myocardial Injury at Early Stage and Its Association with Death Risk of Patients with COVID-19: A Hospital-Based Prospective Case-Cohort Study

“…More and more studies have demonstrated that COVID-19 patients were accompanied with multiple organ injuries, mainly including acute liver injury, acute kidney injury, respiratory failure and even lymphopenia [12][13][14][15]. In the present study, myocardial injury was evaluated through measuring biochemical indexes, such as CK, CKMB, LDH and AST.…”

“…Previous studies found that SARS-CoV-2 mainly evoked severe acute respiratory syndrome. More and more researches revealed that most cases were prone to suffer multiple organ injuries, such as immune system disorder, acute kidney injure and even liver dysfunction [11][12][13]. Nevertheless, the clinical characteristics of myocardial injury caused by SARS-CoV-2 are rarely described.…”

Incidence, patterns, risk factors, and histopathological findings of liver injury in coronavirus disease 2019 (COVID-19): a scoping review

“…Around half of the eligible studies (n=29, 46.8%) showed an association between the severity of COVID-19 and the degree of liver injury. [11][12][13][14][15][16][17][19][20][21][22][23]28,29,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Out of the 27 studies assessing liver injury in COVID-19, 44.4% (n=12) had pre-defined clinical criteria for liver injury, whereas 55.6% (n=15) did not have any specific pre-defined criteria. The details of these studies are given below.…”

“…They have mentioned liver enzyme elevation without commenting on the clinical signs of hepatic dysfunction, which include hepatomegaly, ascites, and jaundice. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]32 The incidence of liver injury has varied widely across studies, from 4.8% to a striking 78%. However, the term 'liver injury' has not been defined uniformly.…”