Can elevated concentrations of ALT and AST predict the risk of ‘recurrence’ of COVID-19?

Abstract

'Recurrence' of coronavirus disease 2019 (COVID-19) has triggered numerous discussions of scholars at home and abroad. A total of 44 recurrent cases of COVID-19 and 32 control cases admitted from 11 February to 29 March 2020 to Guanggu Campus of Tongji Hospital affiliated to Tongji Medical College Huazhong University of Science and Technology were enrolled in this study. All the 44 recurrent cases were classified as mild to moderate when the patients were admitted for the second time. The gender and mean age in both cases (recurrent and control) were similar. At least one concomitant disease was observed in 52.27% recurrent cases and 34.38% control cases. The most prevalent comorbidity among them was hypertension. Fever and cough being the most prevalent clinical symptoms in both cases. On comparing both the cases, recurrent cases had markedly elevated concentrations of alanine aminotransferase (ALT) (P = 0.020) and aspartate aminotransferase (AST) (P = 0.007). Moreover, subgroup analysis showed mild to moderate abnormal concentrations of ALT and AST in recurrent cases. The elevated concentrations of ALT and AST may be recognised as predictive markers for the risk of 'recurrence' of COVID-19, which may provide insights into the prevention and control of COVID-19 in the future.

A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

“…Excluded studies and the reason are shown in appendix pp 107–110. Of the 117 eligible studies, there were 66 case reports [ 5 , 16 – 80 ], 42 case series [ 6 , 81 – 121 ], 3 cohort studies [ [122] , [123] , [124] ], 3 cross-sectional studies [ 125 – 127 ] and 3 case-control studies [ 128 – 130 ]. One hundred studies were from China, 7 from Italy, 3 from Korea, 2 from France, 5 each from Iran, Brunei Darussalam, Switzerland, America and Portugal.…”

“…No infectious strain could be obtained by culture and no full-length viral genomes could be sequenced from RP cases Wu et al [127] China Cross-sectional study – – 46·5 10/60 3–24 d 5 positive 6 positive – – None of the RP patients had clinical symptoms of COVID-19 after hospital readmission, except for occasional cough in patients 1 and 2, both of whom were older than 70 years with multiple co-morbidities. 9 medical staff exposed to one of the RP patients had negative RT-PCR results and had no symptoms in the following 2 months Chen et al [128] China Case control study 27 17 49·68 ± 16·80 44/- 14 d – – – – All the 44 relapse cases were classified as mild to moderate on readmission. in comparison to 32 cases retesting negative after 14 days isolation post-discharge, relapse cases had markedly elevated concentrations of ALT ( P = 0·020) and AST ( P = 0·007).…”

A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations

“…Reviewing cohort studies, case series, and case reports led to finding a total number of 1128 patients with the recurrence of SARS-CoV-2; 957 in cohort studies [1,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], 142 in case series [3,17,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]] and 29 in case report studies . The recurrence rate, which has been defined as positive SARS-CoV-2 RNA detection by RT-PCR test in patients who were recovered (showed negative RT-PCR test), was reported between 2.3% and 21.4% in cohort studies [1,[13][14][15][16][17][18][19][21][22][23][24]…”

“…In eleven cohort studies and case series, positive rates of serum-specific IgM and IgG against SARS-CoV-2 in patients with recurrence ranged 11-95% and 58.8-100%, respectively [13,14,19,[21][22][23]26,27,31,34,45,75]. Although timing of sampling could affect, some pieces of evidence have cast doubt on the protective role of the specific antibodies, concentrations of antibodies needed for conferring protection, and their protection duration in patients who experienced recurrence.…”

Immunoglobulin Response and Prognostic Factors in Repeated SARS-CoV-2 Positive Patients: A Systematic Review and Meta-Analysis

“…The basic characteristics of the included articles are summarized in Table 1 . Out of the 34 included articles, 33 were from China [ 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] and 1 from Italy [ 30 ]. All of the included studies were conducted during the first wave of the COVID-19 pandemic.…”