Characteristics and in-hospital outcomes of COVID-19 patients with abnormal liver biochemical tests

Wu, Yanyan; Ma, Zhuang; Guo, Xiaozhong; Li, Hongyu; Tang, Yufu; Meng, Hao; Yu, Hao; Peng, Chengfei; Chu, Guiyang; Wang, Xinwei; Teng, Yue; Zhang, Quanyu; Zhu, Tianyi; Wang, Bing; Tong, Zhenhua; Feng, Ruyong; Zhao, Haitao; Lü, Hui; Qi, Xingshun

doi:10.1016/j.aohep.2021.100349

Cited by 6 publications

(12 citation statements)

References 12 publications

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“…This may be related to the higher proportion of severe and critically ill patients in the non-recurrent group. Previous studies by Wu et al 38 , 39 have also shown that abnormal liver biochemical indicators increase the risk of poor prognosis for COVID-19 patients, which is consistent with our conclusion. These results indicate that COVID-19 patients with recurrent PCR positivity experienced milder illness at the time of hospital admission compared to non-recurrent patients.…”

Section: Discussionsupporting

confidence: 93%

Clinical features and corresponding immune function status of recurrent viral polymerase chain reaction positivity in patients with COVID-19 : A meta- analysis and systematic review

Ren

Wang

et al. 2021

Int J Immunopathol Pharmacol

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Introduction: Coronavirus disease 2019 (COVID-19) was declared a global pandemic in March 2020. Since then, several studies have found COVID-19 patients with recurrent viral polymerase chain reaction (PCR) positivity. Methods: On May 6, 2021, an exhaustive literature search of the Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure databases, Embase, Wan Fang Data, VIP database, Sinomed database, BioRxiv, MedRxiv, and Research Square was conducted to find describing the laboratory indicators of recurrent and non-recurrent viral PCR positivity in patients with COVID-19. The data were statistically analyzed using STATA version 15.0. Results: In total, 22 studies—comprising 5154 laboratory-confirmed COVID-19 cases—were included in the analyses. Patients with less severe COVID-19 illness (i.e. those clinically classified as mild or common-type) seemed to exhibit recurrent PCR positivity more commonly than patients with more severe illness (i.e. those classified as severe or critical). There were also significant differences between the two groups in terms of the rates of headaches and dizziness, in addition to the levels of aspartate aminotransferase, C reactive protein, interleukin-6, and lactate dehydrogenase. Further, there were variations in the ratio of CD4+ T cells/CD8+ T cells on admission to the hospital. Conclusion: In comparison to COVID-19 patients with non-recurrent viral PCR positivity, patients with recurrent virus PCR positivity seem to experience more severe immune function suppression upon hospital admission.

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Section: Discussionsupporting

confidence: 93%

Clinical features and corresponding immune function status of recurrent viral polymerase chain reaction positivity in patients with COVID-19 : A meta- analysis and systematic review

Ren

Wang

et al. 2021

Int J Immunopathol Pharmacol

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“…Moreover, several studies have shown that abnormalities in liver biochemical tests are more frequent in severe cases of COVID-19 as compared to mild and moderate ones (4,13). The association between abnormalities in liver biochemical tests and worse prognosis (5,6,10,(14)(15)(16)(17)(18) and mortality (19) has also been demonstrated. However, there is a lack of studies on the relationship between elevations of liver transaminases and inflammatory cytokines, seeking to understand these changes as a reflection of the ongoing dynamic between viral infection and the immune response.…”

Section: Introductionmentioning

confidence: 96%

Elevations in Liver Transaminases in COVID-19: (How) Are They Related?

et al. 2021

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Liver involvement in COVID-19 is not yet well-understood, but elevations in liver transaminases have been described to occur in 14–53% of the cases and are more frequently seen in severe disease. This cross-sectional study explored the relationship between the elevations in liver transaminases and inflammatory parameters in 209 adults with COVID-19. Demographic and clinical data, serum levels of inflammatory cytokines and liver aminotransferases were analyzed. Three groups were formed according to the liver transaminase abnormalities: (I) Normal transaminases, (II) Borderline transaminases elevation, and (III) Mild to severe transaminases elevation. Altered liver transaminases were directly related to disease severity, showing association with the NEWS2 score at admission and greater need for ICU or death. Moreover, higher levels of IL-2 and CRP were associated with borderline transaminases elevations, whereas higher levels of IL-10 and Neutrophil to Lymphocyte ratio were associated with mild to severe transaminases elevation. These results reinforce the importance of liver transaminases in patients with COVID-19 as a complementary marker for disease severity and also point to them as a parameter reflecting the continuous dynamics between viral infection and the immune response.

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“…[ 18 ] As a result, mortality was too low in our population (2/554, 0.4%) to demonstrate significant trends, compared with the higher mortality (63/2797, 2.3%) in the prior Chinese study. [ 18 ]…”

Section: Discussionmentioning

confidence: 83%

“…[ 5 ] Beyond transient elevations in transaminases, some patients may experience severe liver injury and develop liver failure. [ 6 ] However, the mechanisms underpinning these derangements, as well as the long-term sequelae of this liver dysfunction remains to be studied. The role of pre-existing liver dysfunction in patients with SARS-CoV-2 infection has also not been well characterized.…”

Section: Introductionmentioning

confidence: 99%

Elevated liver enzymes in hospitalized patients with COVID-19 in Singapore

et al. 2021

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Liver dysfunction in patients with COVID-19 (coronavirus disease 2019) has been described. However, it is not clear if the presence of abnormal liver function tests at presentation was related to underlying undiagnosed liver disease, or a result of the viral infection.We retrospectively examined the first 554 consecutive polymerase chain reaction positive SARS-CoV-2 patients admitted from February 2020 to April 2020 to our academic medical centre. We reviewed their clinical data, chest radiography and laboratory studies obtained within 24 hour of admission.Despite similar hemodynamic parameters, we found significant aspartate transaminase elevation (64 ± 141 vs 35 ± 23 U/L, P < .001) in those with pneumonia compared to those without. Elevated liver enzymes were seen in 102 patients (18.4%). They presented with higher temperatures (38.5 ± 0.9 vs 37.5 ± 0.8 degC, P = .011), higher total white cell counts (6.95 ± 2.29 vs 6.39 ± 2.19 x10 9 /L, P = .021), serum ferritin (240 ± 274 vs 165 ± 198 ng/ml, P = .002) and lactate dehydrogenase (632 ± 912 vs 389 ± 107 U/ L, P < .001). These patients were more likely to require intensive care (6.9% vs 2.7% P = .036) and mechanical ventilation (5.9% vs 2.2%, P = .046). Migrant workers from dormitories had a higher rate of baseline liver function test abnormalities (88/425 vs 14/129, P = .01), which were more likely to persist at the time of discharge.Despite relatively mild COVID-19 disease, there was a significant prevalence of liver dysfunction, particularly amongst migrant workers. Elevated liver enzymes were associated with more severe disease, despite similar haemodynamic characteristics. Future studies should explore whether pre-existing liver disease may predispose to more severe COVID-19 disease.Abbreviations: ALP = alkaline phosphatase, ALT = alanine transaminase, AST = aspartate transaminase, COVID-19 = coronavirus disease 2019, LDH = lactate dehydrogenase, LFT = liver function test, NAFLD = non-alcoholic fatty liver disease, ULN = upper limit of normal.

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Characteristics and in-hospital outcomes of COVID-19 patients with abnormal liver biochemical tests

Cited by 6 publications

References 12 publications

Clinical features and corresponding immune function status of recurrent viral polymerase chain reaction positivity in patients with COVID-19 : A meta- analysis and systematic review

Clinical features and corresponding immune function status of recurrent viral polymerase chain reaction positivity in patients with COVID-19 : A meta- analysis and systematic review

Elevations in Liver Transaminases in COVID-19: (How) Are They Related?

Elevated liver enzymes in hospitalized patients with COVID-19 in Singapore

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