Clinical Features of COVID-19-Related Liver Damage

Abstract

BACKGROUND: A recent outbreak of SARS-CoV-2 infection occurs mainly in China,with rapidly increasing the number of cases (namely . Abnormal liver functions are frequently present in these patients, here we aimed to clarify the clinical features of COVID-19-related liver damage to provide some references for the clinical treatment. A total of 148 cases were analyzed for clinical features, laboratory parameters (including liver function tests), medications and the length of stay. FINDINGS:Of 148 confirmed SARS-CoV-2-infected patients, 49.3% were females and 50.7% were males. The median age was 50.5 years (interquartile range, 36-64).Patients had clinical manifestations of fever (70.1%), cough (45.3%), expectoration (26.7%) at admission. 75 patients (50.7%) showed abnormal liver functions at admission. Patients (n = 75) who had elevated liver function index were more likely to have a moderate-high degree fever (44% vs 27.4%; p = 0.035) and significantly present in male patients (62.67% vs 38.36%; p = 0.005). The numbers of CD4 + and CD8 + T cells were significantly lower in abnormal liver function group than those in normal liver function group. There was no statistical difference in prehospital medications between normal and abnormal liver function groups, while the utilization rate of lopinavir/ritonavir after admission was significantly higher in patients with emerging . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.(which was not peer-reviewed) The copyright holder for this preprint .

Risk factors related to hepatic injury in patients with corona virus disease 2019

“…It's suggested that bile duct epithelial cells may play a key role in immunoreaction. However, clinical data from two researches showed that the bile duct injury related indexes alkaline phosphatase, gamma-glutamyl transpeptidase and total bilirubin did not increase significantly 10,14 .…”

“…Despite atypical pneumonia as the primary symptom, liver dysfunction has also been observed in many clinical cases [7][8][9] , indicating a possibility for the patients with COVID-19 may cause hepatic injury. Except that part of patients receiving lopinavir/ritonavir during hospitalization, which can cause drug-induced hepatic injury 10 , the underlying mechanisms for hepatic injury in patients with COVID-19 are still unclear. And there are few of clinical research regarding on this issue and it remains controversial now.…”

Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now?

“…Likewise, published case studies reporting clinical features of patients with COVID-19 have shown that they may develop different degrees of liver dysfunction (summarized in Table 1). In these studies, the incidence of liver injury ranged from 14.8% to 78%, mainly presenting with abnormal levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) accompanied by slightly elevated bilirubin levels [8][9][10][11][12][13][14][15][16][17][18][19]. A deeper look at available data shows higher rates of abnormal levels in severe COVID-19, as high as 78% in one study [18].…”

“…Importantly, drug-induced liver injury during COVID-19 treatment should be carefully investigated. It might be caused by antiviral medications (lopinavir/ritonavir), antipyretics (acetaminophen), antibiotics (macrolides, quinolones) or steroids [31]. In a paper describing the first 12 patients with COVID-19 in the United States (U.S.), the three hospitalized patients, who received remdesivir at the time of clinical worsening, reported elevated liver enzymes [32].…”

COVID-19 Infection

“…90,91 However, clinical effectiveness remains unproven, and providers should be cognizant of the known side effect profile for this medication and monitor for hepatotoxicity, hyperglycemia, and arrythmias. 92 An ongoing clinical trial is comparing patients randomized to lopinavir/ritonavir and the viral fusion inhibitor arbidol (trial No. NCT04252885).…”