Acute Liver Injury Prevalent in Patients with COVID-19

Virus cells. Coronavirus Covid-19 concept image.
Researchers observed the presence of acute liver injury caused by COVID-19 in patients at multiple hospitals in China.

Researchers observed the presence of acute liver injury (ALI) caused by novel coronavirus 2019 (COVID-19) in patients at multiple hospitals in China, according to results from a systematic analysis published in Digestive and Liver Disease.

Researchers systematically reviewed all manuscripts related to SARS-CoV-2 published between December 1, 2019 and March 25, 2020. Author affiliations were accounted for to avoid inclusion of replicated data. Studies that had information on alanine or aspartate aminotransferase (ALT-AST) and/or total bilirubin levels, gastrointestinal (GI) symptoms, preexisting liver disease, and in-hospital disease progression were included. ALI was defined as an elevation of ALT or AST. In total, 26 articles covering 3109 patients were included in the review. Only 1 study reported severe liver injury and was removed from the review.

The median age of patients was 50 years (interquartile range [IQR], 47-55) and the majority were men (56.0%). GI symptoms were reported in 6.5% (IQR, 3.0%-11.5%) of patients. Some patients (24.5%; IQR, 17.0%-36%) developed ALI during the course of their infections, while only 2% (IQR, 1.0%-9.2%) had underlying liver disease. ALI did not correlate with either GI symptoms (correlation coefficient [cc], 0.22) or liver disease (cc, 0.12).

The majority of ALI was caused by minimally elevated ALT levels (median, 29 U/L; IQR, 24-35 U/L) or elevated ALT (median, 33 U/L; IQR, 30-34 U/L) with normal bilirubin levels (median, 0.64 mg/dL; IQR, 0.57-0.80 mg/dL). The researchers reported a correlation between elevated AST (cc, 0.79) or ALT (cc, 0.78) with transfer to the intensive care unit. Correlations with patient mortality could not be evaluated due to missing data.

One limitation of the review is that researchers could not evaluate specific trends and prognoses of each subject with liver injury because the median values of ALI markers from multiple studies were used in the final systematic analysis. In addition, all of the studies included in the review originated in China, which may limit the generalizability of findings.

The study authors concluded that ALI was not correlated with GI symptoms or underlying liver disease, but that it indicated patients with elevated ALT or AST were more likely to be admitted to the ICU. In the majority of patients, damage to the liver by COVID-19 was minor.

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Debes J D, Anugworm C M, and Aby E S. Systematic analysis of acute liver injury during SARS-CoV-2 infection [available online May 19, 2020]. Dig Liver Dis. doi:10.1016/j.dld.2020.05.006