Evaluation of liver function in symptomatic COVID-19 patients

Abstract

Context: The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14–53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction. Aims: Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients. Settings and Design: This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal. Methods and Material: The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value. Results: From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died. Conclusions: Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.

Prognostic Value of Transaminases and Bilirubin Levels at Admission to Hospital on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

“…Our data are in line with other similar studies in the literature [12][13][14][15][16][17][18][19][20][21][22]. Those studies, mainly performed in the USA, showed a significant association between the increase in liver function and disease progression or death in patients with COVID-19 [20][21][22].…”

“…In addition, the increase in bilirubin levels at time of hospital admission is significantly related to hospital mortality; however, also considering the minor association, further research is required to validate the data shown. Considering the need for tools and prognostic examinations that can help to predict the clinical progression of disease in COVID-19 patients, our study, with others recently published [8][9][10][11][12][13][14][15][16][17][18][19], could be a useful guide, using liver damage and liver function tests to highlight patients at risk of COVID-19 progression or to predict the severity of disease progression.…”

“…Since December 2019 to date, the novel Coronavirus Disease 2019 (COVID- 19) has spread all over the world, and more than 430,000,000 cases and more than 5,000,000 deaths have been registered [1].…”

“…Liver damage is likely multifactorial: it may be due not only to direct viral damage, but also due to a systemic cytokine storm, pro-thrombotic state, drug use and abuse during COVID-19, and hypoxic injury [8]. Finally, several studies have investigated the role of liver enzymes on disease progression and mortality [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], showing a relation between the elevation of liver enzymes, considered as a manifestation of liver damage, and the severity of COVID-19 disease. In addition, the impact that the SARS-CoV-2 pandemic has determined on patients with liver disease has been considerable for both outpatient and inpatient management [23][24][25].…”

Impact of covid-19 pandemic on quality of life and psychosocial difficulties among liver transplant recipients

“…[ 1 ] The morbidity and mortality from COVID-19 are worse in patients with the pre-existing co-morbid illness. [ 2 3 ] Liver transplant (LT) recipients, by virtue of being on immuno-suppressants, represent a vulnerable patient cohort with an increased risk of infection and/or possible severe course of the illness. [ 4 ] The presence of metabolic-related co-morbidities, known to increase with time since transplant might be associated with an increased risk of severe COVID-19 disease and need to be studied which have important public health implications.…”