Abstract
Background: Liver injury commonly occurs in patients with COVID-19. There is limited data describing the course of liver injury occurrence in patients with different disease severity, and the causes and risk factors are unknown. We aim to investigate the incidence, characteristics, risk factors, and clinical outcomes of liver injury in patients with COVID-19.Methods: This retrospective observational study was conducted in three hospitals (Zhejiang, China). From January 19, 2020 to February 20, 2020, patients confirmed with COVID-19 (≥18 years) and without liver injury were enrolled and divided into non-critically ill and critically ill groups. The incidence and characteristics of liver injury were compared between the two groups. Demographics, clinical characteristics, treatments, and treatment outcomes between patients with or without liver injury were compared within each group. The multivariable logistic regression model was used to explore the risk factors for liver injury.Results: The mean age of 131 enrolled patients was 51.2 years (standard deviation [SD]: 16.1 years), and 70 (53.4%) patients were male. A total of 76 patients developed liver injury (mild, 40.5%; moderate, 15.3%; severe, 2.3%) with a median occurrence time of 10.0 days. Critically ill patients had higher and earlier occurrence (81.5 vs. 51.9%, 12.0 vs. 5.0 days; p < 0.001), greater injury severity (p < 0.001), and slower recovery (50.0 vs. 61.1%) of liver function than non-critically ill patients. Multivariable regression showed that the number of concomitant medications (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.05–1.21) and the combination treatment of lopinavir/ritonavir and arbidol (OR: 3.58, 95% CI: 1.44–9.52) were risk factors for liver injury in non-critically ill patients. The metabolism of arbidol can be significantly inhibited by lopinavir/ritonavir in vitro (p < 0.005), which may be the underlying cause of drug-related liver injury. Liver injury was related to increased length of hospital stay (mean difference [MD]: 3.2, 95% CI: 1.3–5.2) and viral shedding duration (MD: 3.0, 95% CI: 1.0–4.9).Conclusions: Critically ill patients with COVID-19 suffered earlier occurrence, greater injury severity, and slower recovery from liver injury than non-critically ill patients. Drug factors were related to liver injury in non-critically ill patients. Liver injury was related to prolonged hospital stay and viral shedding duration in patients with COVID-19.Clinical Trial Registration: World Health Organization International Clinical Trials Registry Platform, ChiCTR2000030593. Registered March 8, 2020.
Highlights
Since December 2019, a newly recognized acute respiratory illness, officially named coronavirus disease-19 (COVID19), has become widespread globally and accounts for considerable human morbidity and mortality over 200 countries, areas, and territories worldwide [1,2,3,4]
This study aims to reveal the course of occurrence, risk factors, and correlations with clinical outcome of liver injury in specific COVID-19 populations
The metabolic interactions were tested in human hepatic microsomes in vitro, and the results showed that the metabolism of arbidol can be significantly inhibited after exposure to different concentrations of lopinavir/ritonavir (p < 0.005, Figure 3), whereas arbidol had no effect on the metabolism of lopinavir/ritonavir (p > 0.05, Figure 3)
Summary
Since December 2019, a newly recognized acute respiratory illness, officially named coronavirus disease-19 (COVID19), has become widespread globally and accounts for considerable human morbidity and mortality over 200 countries, areas, and territories worldwide [1,2,3,4]. According to the latest epidemiological studies, ∼16–53% of patients with COVID-19 experienced different degrees of liver injury [4, 7,8,9,10,11,12,13], and some patients have developed severe liver injury. Some studies have reported the incidence of liver injury in patients with COVID-19 [8, 14, 15], there are limited data describing the course of liver injury occurrence, such as liver injury onset, progression, and recovery, during an entire hospitalization period, in patients with different disease severity. There is limited data describing the course of liver injury occurrence in patients with different disease severity, and the causes and risk factors are unknown. We aim to investigate the incidence, characteristics, risk factors, and clinical outcomes of liver injury in patients with COVID-19
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