Abnormal Liver Function Tests Linked to Severe SARS-CoV-2 Infection

Figure of human liver, laboratory test tube or bottle with blood and paper result of liver function or enzyme test (LFTs) analysis are on doctor table. Concept to represent liver function test or exam
By conducting prospective studies of liver function test abnormalities at baseline, a team of researchers hoped to elucidate the clinical relevance of liver injury in patients with COVID-19.

Abnormal liver function tests (LFTs) at hospital admission, especially gamma-glutamyl transferase (GGT) and hypoalbuminemia, were found to be significantly correlated with severe courses of SARS-CoV-2 infection, according to the results of a study published in Gut.

Liver injury is frequently reported in patients with COVID-19, although the relationship between baseline LFT abnormalities and the course of the disease has not previously been prospectively evaluated. A team of investigators from the University Hospital Munich in Germany conducted a prospective cohort study to evaluate the association of abnormal LFT results at admission and the course of SARS-CoV-2 infection.

From March to July 2020, 217 patients who did not have pre-existing liver disease were prospectively included in the Registry of the LMU Klinikum (CORKUM, WHO trial ID DRKS00021225), and their data were analyzed. All 217 patients were suspected of having or being diagnosed with COVID-19. The definition of a severe course of infection was an admission to an intensive care unit (ICU) or a death related to COVID-19.

The investigators found that abnormal LFT results at baseline were present in 58% of patients, with a predominant elevation of aspartate aminotransferase (AST; 42%), GGT (37%), and alanine aminotransferase (ALT; 27%). Hypoalbuminemia was observed in 33% of patients.

In addition, elevations of ALT and GGT as well as hypoalbuminemia were associated with higher proportions of patients who required ICU treatment and mechanical ventilation. Hypoalbuminemia combined with abnormal AST or GGT at hospital admission was a highly significant independent risk for ICU admission (odds ratio [OR], 46.22 and 38.8, respectively) and for a composite endpoint of ICU admission and/or COVID-19-related death (OR 42.0 and 26.9, respectively) after adjusting for age, gender, and comorbidities.

Although the study was limited by possible bias toward more severe cases of COVID-19, the researchers determined that abnormal LFT results at hospital admission, especially for GGT and hypoalbuminemia, are associated with a more severe course of SARS-CoV-2 infection.

These findings suggest that patients who have baseline hypoalbuminemia combined with other abnormal LFTs, especially abnormal AST or GGT, should be considered at high risk for a severe course of SARS-CoV-2 infection.

In conclusion, a deeper level of awareness regarding the risk factors for a poor SARS-CoV-2 outcome has the potential to mitigate the burden of the virus.


Weber S, Hellmuth JC, Scherer C, Muenchhoff M, Mayerle J, Gerbes AL. Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: a prospective cohort study. Gut. Published online January 29, 2021. doi:10.1136/gutjnl-2020-323800