Abstract
Background and AimWhile many studies have reported on liver injury in patients with coronavirus disease 2019 (COVID‐19), none have specifically addressed the significance of hepatic jaundice. We aimed to determine the clinical consequences and etiologies of jaundice in patients with COVID‐19.MethodsWe retrospectively analyzed clinical features, laboratory abnormalities, and rates of survival and intensive care unit admission in 551 patients with COVID‐19, hospitalized between 1 March 2020, and 31 May 2020 at a tertiary care academic medical center. Hepatic jaundice was defined as a serum total bilirubin concentration >2.5 mg/dL and a direct bilirubin concentration >0.3 mg/dL that was >25% of the total. Liver injury was characterized as cholestatic, mixed, or hepatocellular at the time of peak serum total bilirubin concentration by calculating the R factor.ResultsHepatic jaundice was present in 49 (8.9%) patients and associated with a mortality rate of 40.8% and intensive care unit admission rate of 69.4%, both significantly higher than for patients without jaundice. Jaundiced patients had an increased frequency of fever, leukopenia, leukocytosis, thrombocytopenia, hypotension, hypoxemia, elevated serum creatinine concentration, elevated serum procalcitonin concentration, and sepsis. Nine jaundiced patients had isolated hyperbilirubinemia. Of the 40 patients with abnormally elevated serum alanine aminotransferase or alkaline phosphatase activities, 62.5% had a cholestatic, 20.0% mixed, and 17.5% hepatocellular pattern of liver injury.ConclusionHepatic jaundice in patients with COVID‐19 is associated with high mortality. The main etiologies of liver dysfunction leading to jaundice appear to be sepsis, severe systemic inflammation, and hypoxic/ischemic hepatitis.
Highlights
Jaundice is a hallmark of liver dysfunction
We previously found that total bilirubin concentration (TBIL) or serum direct bilirubin concentration above the laboratory upper limit of normal (ULN) was associated with increased mortality in patients with COVID-19.7 We examined the clinical features and outcomes of hospitalized patients with COVID-19 who had serum direct bilirubin concentrations high enough to cause jaundice and identified common pathologies that led to liver dysfunction
Many studies have explored liver injury and liver blood test abnormalities; hepatic dysfunction manifested by jaundice in patients with COVID-19 has not been a primary focus
Summary
Jaundice is a hallmark of liver dysfunction. Hepatocytes take up unconjugated bilirubin, a product of heme metabolism, conjugate it to bilirubin diglucuronide, and excrete it into the bile.[1,2,3] Conjugated bilirubin is found in serum only in the presence of hepatic dysfunction (or in the ultrarare Rotor and Dubin–Johnson syndromes). While many studies have reported on liver injury in patients with coronavirus disease 2019 (COVID-19), none have addressed the significance of hepatic jaundice. Methods: We retrospectively analyzed clinical features, laboratory abnormalities, and rates of survival and intensive care unit admission in 551 patients with COVID-19, hospitalized between 1 March 2020, and 31 May 2020 at a tertiary care academic medical center. Hepatic jaundice was defined as a serum total bilirubin concentration >2.5 mg/dL and a direct bilirubin concentration >0.3 mg/dL that was >25% of the total. Liver injury was characterized as cholestatic, mixed, or hepatocellular at the time of peak serum total bilirubin concentration by calculating the R factor. The main etiologies of liver dysfunction leading to jaundice appear to be sepsis, severe systemic inflammation, and hypoxic/ischemic hepatitis
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