Patterns of Hepatobiliary Pathologies and Their Relationship with Markers of Inflammation in COVID-19 Patients

Abstract

Background: Altered hepatobiliary status has been reported in association with COVID-19 which has been linked, with limited evidence, to the exaggerated COVID-19-induced hyper-inflammatory response. Hence, the current study evaluated hepatocellular status and its association with indicators of inflammation among COVID-19 patients. Methods: This study was conducted among the RT-PCR-confirmed and treatment-naïve COVID-19 patients in Port Harcourt, South-south Nigeria. Pre-medical/surgical data were retrieved retrospectively from archived patients’ case notes, medical review charts, nurses’ vital signs/medication sheets, and laboratory records at the center using validated data acquisition templates. All retrieved data were analyzed using standard protocols. Results: Among the 396 studied, 16.7% (n=66) had hepatobiliary pathologies. The majority of those with hepatobiliary pathologies had severe COVID-19 (93.3%). Patients with severe COVID-19 and concurrent hepatobiliary pathologies were mostly males and of older age. Cholestatic-specific pathology was the most common pattern observed among the general cases with hepatobiliary pathologies and among those having specific mild, moderate, and severe COVID-19. Among those with severe COVID-19, significant positive relationships were observed between markers of inflammation (Proclacitonin/C-reactive protein/D-dimer) and cholestatic-specific hepatobiliary markers (ALP/G-GT/TBil/CBil) (p<0.05), but not with the hepatocellular-specific markers (ALT/AST) (p>0.05). In contrast, no significant relationship existed between the relevant markers of inflammation and all the cholestatic/hepatocellular markers among those with mild and moderate COVID-19 (p>0.05). Conclusion: Hepatobiliary pathologies, mostly of cholestatic patterns, are frequent among the studied COVID-19 patients which were associated with inflammatory markers among those with severe disease. Therefore, hepatobiliary evaluation should be prioritized, especially among those with severe COVID-19.