Follow‐up evaluation of patients with liver test abnormalities detected during SARS‐CoV2 infection

Abstract

Abnormal liver function tests (A‐LFTs) during admission for coronavirus disease‐19 (COVID‐19) are frequent, but its evolution after COVID‐19 resolution remains unexplored. We evaluated factors related to A‐LFTs during COVID‐19 and assessed the liver outcome after patients' discharge. This is a observational study including: (1) retrospective analysis of variables related to A‐LFTs during COVID‐19; and (2) follow‐up evaluation with blood test, transient elastography and liver biopsy in those with persistent A‐LFTs. A‐LFTs were defined according to CTCAEv4.0. Among 595 patients, 366 (61.5%) showed A‐LFTs. The ratio of partial pressure of oxygen and inspired oxygen fraction (P/F) below 200, ferritin ≥1000 ng/mL, male gender and antibiotic and immunomodulatory treatments were related to A‐LFTs. Follow‐up evaluation was performed in 153 individuals. Persistent A‐LFTs at follow‐up was similar in patients with/without A‐LFTs during admission (14.1% vs. 4.9%, p = 0.104). Fifteen (93%) and 58 (39%) patients with/without A‐LFTs at follow‐up showed metabolic fatty liver disease criteria (p < 0.001), which were histologically confirmed. In conclusion, A‐LFTs during COVID‐19 were related to infection severity. Abnormalities remitted at follow‐up in >80% of patients, and no correlation between A‐LFTs at admission and at follow‐up was found. Most patients with A‐LFTs at follow‐up had non‐invasive and histologically proven fatty liver disease.

Abnormal liver function tests and coronavirus disease 2019: A close relationship

“…Interestingly, in contrast to the study by Canillas et al, 1 the presence of A‐LFTs was associated with worse survival (log rank 8.47, p = .004), while we were able to explore differences based on the type of alteration in the liver profile: In our cohort, the patients with hepatocellular, compared with those with cholestatic liver profile abnormalities, had similar survival rates (log rank 0.33, p = .45), and need for mechanical ventilation (log rank 0.92, p = .81). Finally, although the authors 1 evaluated the ability of interleukin‐6 to discriminate severe COVID‐19 infection showing good performance (AUC: 0.73), it would be more clinically useful to assess the performance of prognostic scores, such as Fibrosis‐4 (FIB‐4) score and C‐reactive protein (CRP) to albumin ratio (CAR), which are based on widely available variables and they have shown very good discriminative ability (AUC > 0.75) for mortality and development of COVID‐19‐related complications. 2 , 3 …”

“…In detail, 700 (53.7%) out of 1304 COVID‐19 patients developed A‐LFTs (ULN for AST/ALT: 40 IU/L and total bilirubin: 1.5 mg/dl) during their hospital stay. As was the case with the study by Canillas et al, 1 the majority developed grade 1 A‐LFTs (589 patients or 45.2%), no patient was diagnosed with liver failure during hospitalization, while 54.2% of the patients with available data had AST and ALT within normal ranges at discharge. In addition, using Cox regression analysis, AST (Hazard Ratio [HR]: 1.01, 95% CI 1.007–1.014, p < .001), fibrinogen (HR: 1.001, 95% CI: 1.00–1.002, p = .02) and remdesivir administration (HR: 1.72, 95% CI 1.20–2.47, p = .003) were the independent baseline (i.e.…”

“…We read with great interest the article by Canillas et al 1 regarding the factors associated with abnormal liver function tests (A‐LFTs) during admission for coronavirus disease‐19 (COVID‐19), as well as the assessment of liver outcome after patient discharge. The authors found that A‐LFTs during COVID‐19 were frequent (366 [61.5%] out of 595 patients showed A‐LFTs), transient and related to the severity of the infection and the use of medications, since ferritin ≥1000 ng/ml and antibiotic/immunomodulatory treatments were independently related to A‐LFTs.…”

“…The authors found that A‐LFTs during COVID‐19 were frequent (366 [61.5%] out of 595 patients showed A‐LFTs), transient and related to the severity of the infection and the use of medications, since ferritin ≥1000 ng/ml and antibiotic/immunomodulatory treatments were independently related to A‐LFTs. 1 However, the authors did not provide the definition of A‐LFTs (i.e. upper limit of normal [ULN] for AST/ALT).…”

“…upper limit of normal [ULN] for AST/ALT). 1 In addition, binary logistic regression was used to explore the association between the development of A‐LFTs with clinical variables, 1 although Cox regression would be more appropriate.…”