Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with abnormal liver function tests. We hypothesized that early altered liver biochemistries at admission might have different clinical relevance than subsequent changes during hospitalization. A single-center retrospective study was conducted on 540 consecutive hospitalized patients, PCR-diagnosed with SARS-CoV-2. Liver test abnormalities were defined as the elevation of either gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST), above the upper limit of normality set by our laboratory. Linear mixed models (LMM) evaluated longitudinal associations, incorporating all available follow-up laboratory chemistries. By the end of the follow-up period, 502 patients (94.5%) were discharged (109 (20.5%) died). A total of 319 (64.3%) had at least one abnormal liver test result at admission. More prevalent were elevated AST (40.9%) and GGT (47.3%). Abnormalities were not associated with survival but with respiratory complications at admission. Conversely, LMM models adjusted for age and sex showed that longitudinal increases during hospitalization in ferritin, GGT, and alkaline phosphatase (ALP), as well as a decreased albumin levels, were associated with reduced survival. This dual pattern of liver damage might reconcile previous conflicting reports. GGT and ALP trajectories could be useful to determine who might need more surveillance and intensive care.
Highlights
Since December 2019, coronavirus disease 2019 (COVID-19) has spread rapidly around the world with high rates of transmission and considerable mortality
We described a dual effect of SARS-CoV-2 infection on liver, characterized by an initial and generalized increase in serum ALT, and AST associated with a reduced oxygen supply
Liver damage is a controversial feature of COVID-19 and its association with clinical outcomes was challenged by some authors [6,10]
Summary
Since December 2019, coronavirus disease 2019 (COVID-19) has spread rapidly around the world with high rates of transmission and considerable mortality. Primarily a respiratory disease, SARS-CoV-2 infection is associated with an increased risk for abnormal liver function Whether this phenomenon is a mere transient biochemistry abnormality, or a surrogate marker of liver injury, is a matter of intense debate. While some authors consider this feature to not to be clinically significant [6,7,8,9,10], others highlighted its as association with adverse outcomes [11,12,13] or reduced survival [14,15,16,17] This controversy is explained in part due to the lack of a consensus on the definition of COVID-19-associated liver injury [18]. Of paramount importance to generate clinically valid evidence from different populations across the world to account for potential ethnic and geographic variability in COVID-19-related liver injury
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