S3536 Liver Function as an Assessment of Disease Progression in COVID-19: A Case Series

Abstract

INTRODUCTION: Since December 2019, the novel coronavirus (COVID-19) has reached pandemic status with over 2 million cases in the US and now over 100,000 deaths. Liver impairment has been reported as a common manifestation of the virus although its current clinical significance remains unclear. We present two cases of patients treated for severe COVID-19 at our institution who experienced significant hepatic injury. CASE DESCRIPTION/METHODS: Case 1:A 78-year-old male with COPD and congestive heart failure was admitted with COVID-19. His admission was complicated by severe hypoxic respiratory failure requiring intubation and a prolonged hospital stay. Throughout his course he sustained worsening hepatic function, with increasing aminotransferases and hyperbilirubinemia in addition to thrombocytopenia, (Table 1). Serum ferritin, LDH, and D-dimer were used as markers of disease severity and appeared to correlate with his LFTs throughout his hospital course, (Table 2). Case 2:A 37-year-old male with no medical history was treated in our ICU with severe COVID-19. On hospital day 13 he developed acute liver injury with significantly elevated transaminitis. His ALT peaked at 2304 U/L, AST at 2376 U/L, alkaline phosphatase at 134 U/L, with a bilirubin of 10.9 mg/dL. Hepatic ultrasound revealed moderate hepatomegaly but no evidence of thrombosis. His liver injury appeared to correlate with worsening respiratory failure and continues to improve as his clinical course stabilizes. DISCUSSION: Liver injury is commonly reported in patients with COVID-19, with abnormalities in LFTs seen in up to 53% of hospitalized patients. The most commonly documented abnormalities are elevated transaminases thought to be caused by the direct pathogenic effect of the virus targeting Angiotensin-Converting Enzyme 2 (ACE2) receptors, which are known to be present on hepatocytes and cholangiocytes. Other potential etiologies for liver injury may be as a result of a cytokine storm the virus triggers or hepatotoxicity from several therapies being trialed, including Remdesivir. Several studies, including one by Cai Qingxian et al., have demonstrated a correlation between abnormal liver function and worsening disease severity, particularly in progressive pneumonitis. While there is robust data on several inflammatory markers for disease progression, there is a paucity of literature on the importance of monitoring LFTs. Further research is vital to better understand the long-term effects of hepatic impairment as a result of COVID-19.Table 1.: Liver Function Labs TrendTable 2.: Inflammatory Marker Trend