Dali Zhang, Zhenyu Zhu, Jingfeng Bi, Danni Feng, Lijuan Zhang, Hongling Liu, Yinjie Gao
Liver Transplantation and Research Center, The 5th Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China (mainland)
Med Sci Monit 2020; 26:e928849
Available online: 2020-11-10
Emerging studies noted that liver injury in coronavirus disease 2019 (COVID-19) patients may be induced by virus-mediated inflammation, which was confirmed by liver pathology. The aim of this study was to observe clinical characteristics and explore risk factors in COVID-19 patients with liver injury.
MATERIAL AND METHODS: In this retrospective study, 40 confirmed COVID-19 patients with normal alanine transaminase (ALT) on admission were divided into a group of normal ALT patients whose ALT was always less than 40 U/l during hospitalization and a group of elevated ALT patients whose ALT was at least once more than 40 U/l after admission. Clinical data, especially virus-induced inflammatory parameters, were analyzed for risk factors and predictive value. The Mann-Whitney U test and t test for comparing means and logistic regression were performed for analysis of risk factors. Area under the ROC curve was used for predictive values.
RESULTS: Sixteen of 40 (40.0%) patients developed elevated ALT, many of them with more severe COVID-19. The highest ALT level was 101 U/l. The risk factors for liver injury were C-reactive protein (CRP), interleukin 6 (IL6), erythrocyte sedimentation rate (ESR), CD8+T cell count, and severity of disease, and CRP (OR 1.13, 95% CI 1.045-1.222, p=0.002) was the independent risk factor.
CONCLUSIONS: Liver injury in COVID-19 patients was mild and associated with inflammatory markers, especially CRP, which suggests that liver injury may be induced by virus-mediated inflammation in COVID-19 patients.
Keywords: COVID-19, drug-induced liver injury, Systemic Inflammatory Response Syndrome