Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients

Abstract

Background: Recent studies reported that patients with coronavirus disease-2019 (COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) have been shown.

Methods: This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group (n = 79) and severe group(n = 26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined.

Results: 56.2% (59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4% (96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range (ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group (P < 0.05). The percentage of the patients with elevated both ALT and AST was 12.7% (10/79) in mild cases vs. 46.2% (12/26) in severe cases (P = 0.001). 34.6% (9/26) severe group patients started to have abnormal ALT after admission, and 73.3% (77/105) of all patients had normal ALT before discharge.

Conclusions: Elevated liver function index is very common in patients with COVID-19 infection, and the level were less than 3 × ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.

Keywords: Coronavirus disease-2019; Dynamic change; Liver function.

Fig. 1

The flow of patient enrollment. From January 12, 2020 to March 17, 2020, 199 patients were admitted to Beijing Ditan Hospital, Capital Medical University. One hundred twenty three patients were discharged and 1 patient was died of COVID-19. One hundred nine patients were old than 18 years. But data of 4 patients were incomplete. At last, 105 patients were enrolled into this study

Fig.  2

Single or combination analysis of indexes during hospitalization in mild vs. severe cases using different cut-off values. Using the cut-off value as 1, 2, or 3 × ULN, respectively, the differences of the overall distribution and the abnormal rates of liver function indexes between the two groups were analyzed. Most of the elevated liver function index were less than 3 × ULN. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group

Fig.  3

Dynamics of liver function indexes in 1 mild type patient with ALT elevation. A 45-year-old man has ALT > 7 × ULN (357.0 U/L) upon admission. He was admitted to the hospital on January 28, 2020 with a diagnosis of COVID-19. During the treatment, ALT gradually returned to normal. After 2 consecutive negative test for SARS-CoV-2 (on February 10, 2020 and February 12, 2020), he was discharged