COVID-19 associated variations in liver function parameters: a retrospective study

Saini, Ram Krishan; Saini, Neha; Ram, Sant; Soni, Shiv Lal; Suri, Vikas; Malhotra, Pankaj; Kaur, Jyotdeep; Verma, Indu; Sharma, Sonal; Zohmangaihi, Deepy

doi:10.1136/postgradmedj-2020-138930

Cited by 60 publications

(54 citation statements)

References 30 publications

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“…Different mechanisms are pointed to the possible effect of the SARS-CoV-2 Virus on liver; the virus could directly affect the hepatocytes or the liver could get injured indirectly through enhanced inflammatory response due to the raised immune markers and drug toxicity that are meant to treat or halt the progression of the disease resulting in liver damage and thereby an increase in liver enzymes [ 31 ]. Raised in liver enzymes associated with more severe disease category is also reported in other studies [ 10 – 15 ].…”

Section: Discussionsupporting

confidence: 83%

“…Deranged cell counts, like anemia, polycythemia, leukopenia and leukocytosis with neutrophil predominance and decreased platelet count are found to be associated with severe disease and worse outcome in hospitalized patients [2][3][4][5][6][7][8][9]. Similarly raised liver enzymes and total bilirubin levels were identified in severe and critical patients [6,[10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

et al. 2021

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Aim To identify laboratory biomarkers that predict disease severity and outcome among COVID-19 patients admitted to the Millennium COVID-19 Care Center in Ethiopia. Methods A retrospective cohort study was conducted among 429 COVID-19 patients who were on follow up from July to October 2020. Data was described using frequency tables. Robust Poisson regression model was used to identify predictors of COVID-19 severity where adjusted relative risk (ARR), P-value and 95 CI for ARR were used to test significance. Binary Logistic regression model was used to assess the presence of statistically significant association between the explanatory variables and COVID-19 outcome where adjusted odds ratio (AOR), P-value and 95%CI for AOR were used for testing significance. Results Among the 429 patients studied, 182 (42.4%) had Severe disease at admission and the rest 247 (57.6%) had Non-severe disease. Regarding disease outcome, 45 (10.5%) died and 384 (89.5%) were discharged alive. Age group (ARR = 1.779, 95%CI = 1.405–2.252, p-value <0.0001), Neutrophil to Lymphocyte ratio (NLR) (ARR = 4.769, 95%CI = 2.419–9.402 p-value <0.0001), Serum glutamic oxaloacetic transaminase (SGOT) (ARR = 1.358, 95%CI = 1.109–1.662 p-value = 0.003), Sodium (ARR = 1.321, 95%CI = 1.091–1.600 p-value = 0.004) and Potassium (ARR = 1.269, 95%CI = 1.059–1.521 p-value = 0.010) were found to be significant predictors of COVID-19 severity. The following factors were significantly associated with COVID-19 outcome; age group (AOR = 2.767, 95%CI = 1.099–6.067, p-value = 0.031), white blood cell count (WBC) (AOR = 4.253, 95%CI = 1.918–9.429, p-value = 0.0001) and sodium level (AOR = 3.435, 95%CI = 1.439–8.198, p-value = 0.005). Conclusions Assessing and monitoring the laboratory markers of WBC, NLR, SGOT, sodium and potassium levels at the earliest stage of the disease could have a considerable role in halting disease progression and death.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Different mechanisms are pointed to the possible effect of the SARS-CoV-2 Virus on liver; the virus could directly affect the hepatocytes or the liver could get injured indirectly through enhanced inflammatory response due to the raised immune markers and drug toxicity that are meant to treat or halt the progression of the disease resulting in liver damage and thereby an increase in liver enzymes (30). Raised in liver enzymes associated with more severe disease category is also reported in other studies (10-15).…”

Section: Discussionsupporting

confidence: 84%

“…Deranged cell counts, like anemia, polycythemia, leukopenia and leukocytosis with neutrophil predominance and decreased platelet count are found to be associated with severe disease and worse outcome in hospitalized patients (2)(3)(4)(5)(6)(7)(8)(9). Similarly raised liver enzymes and total bilirubin levels were identified in severe and critical patients (6,(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 97%

Laboratory Biomarkers of COVID-19 Disease Severity and Outcome: Findings from a Developing Country

Leulseged

Hassen

Ayele

et al. 2021

Preprint

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AimTo identify laboratory biomarkers that predict disease severity and outcome among COVID-19 patients admitted to the Millennium COVID-19 Care Center in Ethiopia.MethodsA retrospective cohort study was conducted among 429 RT-PCR confirmed COVID- 19 patients who were on follow up from July to October 2020 and with complete clinical and laboratory data. Data was described using frequency tables. Robust Poisson regression model was used to identify predictors of COVID-19 disease severity where adjusted relative risk (RR), P-value and 95% CI for RR were used to test significance and interpretation of results. Binary Logistic regression model was used to assess the presence of statistically significant association between the explanatory variables and COVID-19 disease outcome where adjusted odds ratio, P- value and 95% CI for adjusted odds ratio were used for testing significance and interpretation of resultsResultsAmong the 429 patients studied, 182 (42.4%) had Severe disease at admission and the rest 247 (57.6%) had Non-severe disease (15.6% mild and 42.0% moderate). Regarding disease outcome, 45 (10.5%) died and 384 (89.5%) were discharged alive. Age group (ARR= 1.779, 95% CI= 1.405- 2.252, p-value < 0.0001), Neutrophil to Lymphocyte ratio (NLR) (ARR= 4.769, 95% CI= 2.419 - 9.402 p-value <0.0001), Serum glutamic oxaloacetic transaminase (SGOT) (ARR= 1.358, 95% CI= 1.109- 1.662 p-value=0.003), Sodium (ARR= 1.321, 95% CI= 1.091- 1.600 p-value=0.004) and Potassium (ARR= 1.269, 95% CI= 1.059-1.521 p-value=0.010) were found to be significant predictors of COVID-19 disease severity.The following factors were significantly associated with COVID-19 disease outcome; age group (AOR= 2.767, 95% CI= 1.099 - 6.067, p-value=0.031), white blood cell count (AOR= 4.253, 95% CI= 1.918 - 9.429, p-value=0.0001) and sodium level (AOR= 3.435, 95% CI= 1.439, 8.198, p-value=0.005).ConclusionsThe laboratory markers of NLR of above three, raised SGOT and deranged sodium and potassium levels (both hypo- and hyper-states) were found to be significant predictors of developing severe COVID-19 disease. In addition, deranged values of white blood cell count and sodium levels were significantly associated with worse outcome of the disease. Therefore, assessing and monitoring these laboratory markers at the earliest stage of the disease could have a considerable impact in halting disease progression and death.

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“… 20 Saini et al retrospectively analysed liver function tests of 170 patients with confirmed COVID-19, and also found number of patients with raised levels of any of the liver enzymes were 89 (58.5%), out of which 43 (48.31%) had liver injury, which manifested as increased severity in terms of ICU requirement (p=0.0005). 22 In this study, abnormal liver parameters during hospitalization are associated with illness severity and mortality of COVID-19, with the strongest associations observed between peak liver tests and severe COVID-19, as well as peak liver tests and death. Based on previous studies and our results, we suggested monitoring levels of liver function parameters, which could assist in the optimum management of patients with COVID-19.…”

Section: Discussionmentioning

confidence: 59%

Dynamic Changes in Liver Function Tests and Their Correlation with Illness Severity and Mortality in Patients with COVID-19: A Retrospective Cohort Study

Xu¹,

Huang²,

Ling³

et al. 2021

CIA

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Objective To describe the longitudinal changes in liver function tests, and their association with illness severity and mortality in patients with COVID-19. Methods A retrospective cohort study of 1003 hospitalized patients with COVID-19 was conducted. Longitudinal liver function tests and clinical outcomes were analyzed. Results Abnormal liver function parameters were observed, both at admission (ALT 13.2%, AST 8.5%, ALP 2.0%, GGT 7.4%, LDH 37.6%, TBIL 4.0%, DBIL 7.8%, Albumin 10.1%) and peak hospitalization (ALT 29.4%, AST 17.5%, ALP 2.6%, GGT 13.4%, LDH 49.4%, TBIL 10.1%, DBIL 18.0%, Albumin 30.6%) in patients with COVID-19. Compared with non-severe patients, severe patients had markedly higher liver function parameters from baseline to 30 days after hospital admission. Abnormal ALT and LDH at hospital admission and some medications use (Hydroxychloroquine, Lopinavir/Ritonavir, and Traditional Chinese medicines) were associated with peak hospitalization ALT > 5× the upper limit unit of normal (ULN). On multivariate analysis, age >60 years, male, obesity, comorbidity, abnormal LDH and albumin at hospital admission and peak hospitalization were associated with progression to severe COVID-19 (OR > 1; p < 0.05). COX analysis revealed that ALT > 2 ULN (HR=7.0, p =0.011), AST > 2 ULN (HR=34.7, p < 0.001), and TBIL > 2 ULN (HR=54.6, p < 0.001) were associated with a higher mortality. Conclusion Dynamic abnormalities of liver function parameters are common in hospitalized patients with COVID-19, and associated with illness severity and mortality.

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COVID-19 associated variations in liver function parameters: a retrospective study

Cited by 60 publications

References 30 publications

Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

Laboratory Biomarkers of COVID-19 Disease Severity and Outcome: Findings from a Developing Country

Dynamic Changes in Liver Function Tests and Their Correlation with Illness Severity and Mortality in Patients with COVID-19: A Retrospective Cohort Study

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