Systemic inflammation as fuel for acute liver injury in COVID-19

Abstract

Background A cytokine storm conceivably contributes to manifestations of corona virus disease (COVID-19). Inflammatory cytokines such as interleukin-6 (IL-6) cause acute liver injury while serum detectability indicates systemic inflammation. Aims We explored a link between systemic IL-6, related acute phase proteins and liver injury in hospitalized COVID-19 patients. Methods 655 patients with suspected COVID-19 were screened in the emergency department at the University Hospital of Innsbruck, Austria, between February and April 2020. 96 patients (∼15%) were hospitalized with COVID-19. 15 patients required intensive-care treatment (ICT). Plasma aminotransferases, alkaline phosphatase, bilirubin, and gamma glutamyl transferase, as well as IL-6, C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) were determined by standard clinical assays. Results Of all hospitalized COVID-19 patients, 41 (42%) showed elevated aspartate aminotransferase (AST) concentration. COVID-19 patients with elevated AST exhibited significantly higher IL-6 ( p < 0.001), ferritin ( p < 0.001), LDH ( p < 0.001) and CRP ( p < 0.05) serum concentrations compared to patients with normal AST. Liver injury correlated with systemic IL-6 ( p < 0.001), CRP ( p < 0.001), ferritin ( p < 0.001) and LDH ( p < 0.001) concentration. In COVID-19 patients requiring ICT, correlations were more pronounced. Conclusion Systemic inflammation could be a fuel for hepatic injury in COVID-19.

Abnormal Liver Function Test in Patients Infected with Coronavirus (SARS-CoV-2): A Retrospective Single-Center Study from Spain

“…In a larger American cohort that included 5700 patients, 59% and 39% showed AST and ALT values above ULN, respectively [ 10 ]. In agreement with our data, two independent studies from Northern Italy [ 12 ] and Austria [ 15 ] demonstrated upregulation of AST in 44% and 42% of admitted patients with SARS-CoV-2, respectively. In contrast, fewer patients (only 16% and 20%) had abnormal AST levels in the studies from Zhejiang Province [ 4 ] and Rome [ 13 ].…”

“…Specifically, in the liver, the effect of COVID-19 has been evaluated in relatively few studies, which focused on alterations in liver histopathology and biochemistry during the course of infection in patients who succumbed to the virus [ 3 , 4 , 5 , 6 , 7 , 8 ]. Several up-to-date studies have attempted to evaluate parameters related to liver injury in American and Asian cohorts [ 3 , 8 , 9 , 10 , 11 ], as well as in European cohorts [ 12 , 13 , 14 , 15 ]. Yet liver disease in the context of SARS-CoV-2 infection remains largely unknown, thus minimizing the understanding of abnormal liver function in terms of the overall outcome.…”

Liver injury in the era of COVID-19

“…Wang et al [ 69 ] concluded after studying 657 patients infected with SARS-CoV-2 in Wuhan that not only male sex, but also serum concentration of high sensitivity CRP ≥ 10 mg/L and a neutrophil-to-lymphocyte ratio ≥ 5 predispose to liver injury during the course of COVID-19, defined in this survey as a serum level of ALT or total bilirubin greater than the ULN. Thus, an inflammatory background may be closely related to liver function impairment as a complication of the disease[ 70 , 71 ]. Metabolic syndrome and isolated hepatic steatosis were also evaluated as potential risk factors for liver dysfunction during the course of SARS-CoV-2 infection.…”

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

“…COVID-19 mainly leads to acute respiratory symptoms, including fever, dry cough, and dyspnea. Besides, 16-76% of COVID-19 patients manifest as varying degrees of abnormal liver biochemistry tests[ [2] , [3] , [4] ], which are secondary to viral infection of liver cells, liver hypoxia, drug-induced liver injury, and immune-inflammatory reaction[ 5 , 6 ]. Notably, a minority of them may progress into liver failure[ 7 ].…”