Features of liver injury related to COVID-19

Abstract

Objective — to study the character of liver function tests’ changes in patients with COVID — 19, assess the rate of their onset, their clinical and laboratory manifestations and degree of COVID‑19 effects on the liver function with the purpose to implement treatment and preventive measures.
 Materials and methods. The study included 120 medical records of inpatients with COVID‑19, hospitalized in the departments of Clinical Hospital № 8, reprofiled to the infectious wards in the period between November 2020 and April 2021. The most patients were aged 60 — 69 years (41.7 %) and older than 70 years (25.0 %), the minor portion was younger than 40 years (1.7 %); women prevailed (65.0 %).
 Results. The increased hepatic transaminases levels were revealed in 52 % of patients, and total bilirubin (especially indirect) was raised in 15 %. Higher transaminases levels, severe course of coronaviral disease and unfavorable prognosis were more common in male patients. Frequency of SARS‑CoV‑2 — associated liver injury with minimal grade of activity of liver transaminases prevailed in women older than 60 years and men aged 50 to 69 years. COVID‑19‑associated hepatitis with moderate activity was observed in women aged 50 — 69 years and men of working age (40 — 49 years) and elderly (> 70 years) patients, high degree of transaminases’ activity against COVID‑19 background was registered only in men aged 40 — 59 years with moderate to severe COVID‑19 course. Lethal outcomes due to severe pulmonary injury were registered in 19 patients with severe COVID‑19 course; they also had liver dysfunction. From them, 11 had diagnosed liver steatosis before COVID‑19. The most part of deсeased due to COVID‑19 were older than 60 years and had a history of comorbidities (type 2 diabetes mellitus, hypertension, coronary heart disease, non‑alcoholic fatty liver disease, liver cirrhosis and 2 — 3 grade obesity).
 Conclusions. Hepatic impairment occurred in 52 % of inpatients with COVID‑19. All patients with moderate course of coronaviral disease demonstrated positive dynamics of transaminases and bilirubin levels and favorable prognosis after hospitalization due to COVID‑19. Most of them hadn’t had liver injuries before coronaviral disease and six patients had been diagnosed with liver diseases before COVID‑19. No cases of fatal liver failure were registered. After in‑hospital treatment, the transaminases levels were lower in patients, who hadn’t had history of liver diseases before COVID‑19 and received hepatoprotective drugs. Treatment with glutathione and ursodeoxycholic acid was confirmed as the most effective therapy in patients with coronaviral disease.