Abnormal liver function tests in patients with COVID-19

Abstract

Aim: To evaluate features of changes of liver function tests (LFTs) in COVID-19. Methods: We included 50 patients with confirmed COVID-19 and abnormal LFTs. The average age was 55 [46; 66]. 45 patients (90%) were with COVID-19 associated pneumonia. Lung damage involvement according to lungs computed tomography ranged from 5% to 70%. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), quik’s prothrombin and total protein were analyzed. Results: The debut of liver cytolysis was on average 8 [7; 11] sick days of COVID-19. ALT levels elevated on average 2,28 [1,41; 3,27] times. An increase in AST correlated with changes in ALT (r=0,86; p<0,05), it was 2,08 [1,44; 3] times. De Ritis ratio was 0,73 [0,49; 1,15]. Only 2 patients (4%) had hyperbilirubinemia. 60% patients had an increase in GGT - 1,92 [0,79; 3,05] times. 1,79 times ALP was in one patient only. Many patients had not signs of hepatocellular insufficiency - only 5 patients (10%) had decrease in Quik’s prothrombin; hypoproteinemia was observed in 7 patients (14%). The changes in LFTs were reversible, normalization of ALT was achieved in 67%, AST - in 76% of patients within a month. The levels of ALT (r=0,52; p<0,05) and AST (r=0,48; p<0,05) correlated with ferritin. Conclusions: Abnormal LFTs in COVID-19 were characterized by increase in ALT, AST, GGT and decreased de Ritis ratio. Total bilirubin, ALP, Quik’s prothrombin were normal in most patients. The identified changes in the majority of cases returned to normal within the month.