Clinical characteristics and risk factors of liver injury in COVID-19: a retrospective cohort study from Wuhan, China

Ming Wang,Mingyou Xing,Lin Zhu,Xiaojing Wang,Qin Ning,Tao Chen,Weina Li,Wei Guo,Ke Ma,Ming Ni,Hongwu Wang,Weipeng Qi,Haijing Yu,Meifang Han,Di Wu,Xiaoping Luo,Weiming Yan,Hongfang Ding,Dong Xu,Guang Chen,Dong Xi

doi:10.1007/s12072-020-10075-5

Ming Wang, Mingyou Xing + Show 19 more

Open Access

https://doi.org/10.1007/s12072-020-10075-5

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Abstract

BackgroundCoronavirus disease 2019 (COVID-19) has rapidly become a major international public health concern. This study was designed to evaluate the clinical characteristics and risk factors of COVID-19-associated liver injury.MethodsA fraction of 657 COVID-19 patients were retrospectively analyzed. Clinical and laboratory data were derived from electronic medical records and compared between patients with or without liver injury. Multivariate logistic regression method was used to analyze the risk factors for liver injury.ResultsAmong 657 patients, 303 (46.1%) patients had liver injury with higher rate in severe/critically ill patients [148/257 (57.6%)] than those in moderate cases [155/400 (38.8%)]. The incidence of liver injury was much higher in male [192/303 (63.4%)] than female [111/303 (36.6%)], and in severe/critical patients [148/303 (48.8%)] with percutaneous oxygen saturation ≤ 93% [89/279 (31.9%)] or peak body temperature ≥ 38.5 °C [185/301 (61.5%)] on admission. Liver injury-related inflammations included increased white blood cells, neutrophils and decreased lymphocytes. More patients with liver injury than without had increased serum IL-2R, TNFα, ferritin, hsCRP, PCT, ESR, γ-GT, and LDH. Multivariate regression analysis revealed that increasing odds of liver injury were related to male, higher serum hsCRP (≥ 10 mg/L), and neutrophil-to-lymphocyte ratio (NLR) (≥ 5). Moreover, more deceased patients (14/82 (17%)) had significantly elevated serum TBIL than discharged patients [25/532 (4.7%)].ConclusionLiver injury is a common complication in COVID-19 patients. The potential risk factors of liver injury include male, hsCRP and NLR score. A close monitor of liver function should be warned in COVID-19 patients, especially in severe/critical individuals.

Highlights

The ongoing outbreak of Coronavirus disease 2019 (COVID-19) has been recently becoming a pandemic [1]
The results showed serum ALT, total bilirubin (TBIL) and γ-GT all correlated with hypersensitive C-reactive protein (hsCRP) and ferritin; TBIL and γ-GT correlated with IL-2R, TNFα and PCT
The present study showed that liver injury was more prevalent in male, severe or critically ill patients with percutaneous oxygen saturation ≤ 93% or peak temperature ≥ 38.5 °C on admission, and comprehensively delineated the risk factors for COVID-19-associated liver injury

Summary

Introduction

The ongoing outbreak of Coronavirus disease 2019 (COVID-19) has been recently becoming a pandemic [1]. Of 99 patients with COVID-19 enrolled in Wuhan Jinyintan Hospital, among whom 43 patients with different degrees of abnormal liver function were admitted to intensive care unit (ICU). Wang et al showed that patients admitted to ICU had significantly higher ALT levels [5].Guan et al extracted the currently largest cohort regarding 1099 mainly moderate SARS-CoV-2 infected patients and showed 39.4% with severe disease had elevated AST and 28.1% had elevated ALT, and the proportion was 18.2% and 19.8% in patients with non-severe disease [6].Given that the number of patients in these studies is relatively small, information about the clinical characteristics of liver injury in these patients is scarce. To our knowledge, there are few reports that analyzed risk factors of liver injury in COVID-19 patients. This current study aims to analyze the clinical characteristics of COVID-19 patients with liver injury, and evaluate the potential risk factors for the development of liver injury

Methods

Discussion

Findings

Compliance with ethical standards