Acute Liver Injury in Patients Hospitalized with COVID-19

Abstract

Introduction The prevalence and significance of acute liver injury in patients with COVID-19 are poorly characterized. Methods Patients with confirmed COVID-19 who were hospitalized in geographically diverse medical centers in North America were included. Demographics, symptoms, laboratory data results, and outcomes were recorded. Linear and logistic regression identified factors associated with liver injury, in-hospital mortality, and length of stay (LOS). Results Among 1555 patients in the cohort, most (74%) had an elevated alanine aminotransferase (ALT) during hospitalization, which was very severe (> 20 × upper limit of normal [ULN]) in 3%. Severe acute liver injury (ALI) was uncommon, occurring in 0.1% on admission and 2% during hospitalization. No patient developed acute liver failure (ALF). Higher ALT was associated with leukocytosis (per mL 3 ) (β 10.0, 95% confidence interval (CI) 6.7–12.6, p < 0.001) and vasopressors use (β 80.2, 95%CI 21.5–138.8, p = 0.007). In-hospital mortality was associated with ALT > 20 × ULN (unadjusted OR 6.0, 95%CI 3.1–11.5, p < 0.001), ALP > 3 × ULN (unadjusted OR 4.4, 95%CI 2.5–7.7, p < 0.001), and severe ALI (unadjusted OR 6.8, 95%CI 3.0–15.3, p < 0.001) but lost significance after adjusting for covariates related to severe COVID-19 and hemodynamic instability. Elevated ALP and ALT were associated with longer LOS, admission to intensive care, mechanical ventilation, vasopressor use, and extracorporeal membrane oxygenation use ( p < 0.001). Conclusions Transaminase elevation is common in hospitalized patients with COVID-19. Severe ALI is rare, and ALF may not be a complication of COVID-19. Extreme elevations in liver enzymes appear to be associated with mortality and longer LOS due to more severe systemic disease rather than SARS-CoV-2-related hepatitis. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-021-07230-9.

Clinical features and predictive factors related to liver injury in SARS-CoV-2 Delta and Omicron variant-infected patients

“…We also explored the ratio of liver injury during hospitalization, and the results showed that only four Delta and one Omicron variant-infected patients experienced liver injury during hospitalization. Previous studies have shown that liver injury occurs in some COVID-19 patients during hospitalization, but the results vary greatly and significantly higher than our results [24,25]. In this study, only 5 (3.2%) SARS-CoV-2-infected patients experienced in-hospital liver injury, RUCAM scores of two patients supported that liver injury was related to the use of analgesic-antipyretic drugs whereas three patients were considered to be related to SARS-CoV-2 infection.…”

Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients’ outcomes: a single-center Greek study

“…However, at baseline, only 1% and 0.2% of the patients had LI (i.e., AST>200 IU/L) or AST >400 IU/L, respectively. Thus, in accordance with previous studies [ 10 , 14 , 15 ], we confirmed that liver biochemistry abnormalities in COVID-19 patients are usually mild and predominantly hepatocellular, while AST values are more frequently abnormal than ALT. Nevertheless, no indication for liver dysfunction was observed, since no severe abnormalities in INR were recorded (range 0.7-1.3 in patients not receiving anticoagulants).…”

Coronavirus disease 2019 and the liver

“…The pooled prevalence of CLD in hospitalized COVID-19 patients is 3% and similar to uninfected patients [57 ▪▪ ]. The prevalence of advanced fibrosis or cirrhosis in hospitalized COVID-19 patients is 1% [15 ▪ ,16 ▪ ]. Sixty percentage of patients with CLD develop severe COVID-19 [58].…”

“…In observational studies of hospitalized patients with COVID-19, aminotransferases were elevated on admission in 20–67%, with 61–83% developing elevated aminotransferases during hospitalization [12,13,14 ▪ –16 ▪ ,17–19]. Aminotransferase elevations are usually less than 3–5 times the upper limit of normal (ULN) [14 ▪ –16 ▪ ]. Elevated serum alkaline phosphatase (ALP) and total bilirubin have been observed in 23–30 and 4–16% of hospitalized patients, respectively [15 ▪ ,16 ▪ ,17].…”