An evaluation of liver function tests in severe acute respiratory syndrome - Corona virus 2 (SARS-CoV-2) infection in the backdrop of chronic kidney disease

Abstract

Background: The SARS-CoV-2 pandemic has emerged as the most challenging global health problem of this century. The concomitant presence of co-morbidities like chronic kidney disease (CKD), diabetes, CHD, further complicates the problem. Aim: To assess the patterns of LFT abnormalities in patients of SARS-CoV-2 infection with and without CKD and evaluate the probable outcomes. Materials and Methods: A cross-sectional retrospective observational study done on 600 patient samples (Group 1: SARS-CoV-2 without CKD, Group 2: SARS-CoV-2 with CKD and Group 3: CKD uninfected with SARS-CoV-2) which were processed for LFT and KFT. Results: AST and ALT were significantly higher in all SARS-CoV-2 infected; Group 1 mean ± 2SD, (63.63 ± 42.89U/L & 50.25 ± 46.53U/L), group 2 (90.59 ± 62.51U/L & 72.09 ± 67.24 U/L) as compared to Group 3 (25.24 ± 7.47U/L & 24.93 ± 11.44U/L). A statistically significant elevation is seen in these two parameters in Group 2 as compared to Group 1. There was a negative significant correlation between eGFR and AST/ALT levels in Group 1 ( p < 0.05). In Group 2, a weak positive correlation was seen with ALT. Group 3, eGFR’s showed strong correlations with AST and ALT levels; reduction in kidney function correlated well with increase in serum ALP levels. Conclusions: This study establishes that SARS-CoV-2 infected, with CKD, show higher elevations in serum aminotransferase levels in comparison to those without CKD. In contrast, the CKD group not infected, shows a decline in serum aminotransferase levels. Serum ALT values in SARS-CoV-2 show significant correlation with eGFR. Also, elevated ALP values in CKD patients may be used as an indicator of declining kidney function.

A multicenter study of severity and prognosis of symptomatic COVID‐19 in end‐stage renal disease and non‐dialysis patients in East of Iran

“…Thus, they concluded that elevated ALP values in CKD patients with COVID-19 infection may be used as an indicator of declining kidney function. 32 This contradiction between different studies needs more investigation in future studies. Generally, liver damage can be a result of underlying conditions in these individuals, COVID-19 itself, or the therapeutic interventions performed on these patients.…”

“…SARS‐CoV‐2 positive CKD patients were found by Kumar et al to have higher serum aminotransferase levels than their non‐CKD COVID‐19‐positive counterparts, and these levels were significantly correlated with calculated eGFR values. Thus, they concluded that elevated ALP values in CKD patients with COVID‐19 infection may be used as an indicator of declining kidney function 32 . This contradiction between different studies needs more investigation in future studies.…”