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. 2021 Apr;70(4):733-742.
doi: 10.1136/gutjnl-2020-321726. Epub 2020 Jul 8.

Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19

Terry Cheuk-Fung Yip  1 , Grace Chung-Yan Lui  2 , Vincent Wai-Sun Wong  1 , Viola Chi-Ying Chow  3 , Tracy Hang-Yee Ho  4 , Timothy Chun-Man Li  4 , Yee-Kit Tse  1 , David Shu-Cheong Hui  2 , Henry Lik-Yuen Chan  1 , Grace Lai-Hung Wong  5
Affiliations

Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19

Terry Cheuk-Fung Yip et al. Gut. 2021 Apr.

Abstract

Objective: Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear.

Design: This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death.

Results: We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation.

Conclusion: ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.

Keywords: cholestasis; hepatitis; liver function test.

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Conflict of interest statement

Competing interests: TC-FY has served as an advisory committee member and a speaker for Gilead Sciences. GC-YL has served as an advisory committee member for Gilead, Merck and GSK, speaker for Merck and Gilead, and received research grant from Gilead, Merck and GSK. VW-SW has served as an advisory committee member for 3V-BIO, AbbVie, Allergan, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Janssen, Novartis, Novo Nordisk, Perspectum Diagnostics, Pfizer, TARGET-NASH and Terns; and a speaker for Bristol-Myers Squibb, Echosens, Gilead Sciences and Merck. He has also received a research grant from Gilead Sciences. HLYC is an advisor for AbbVie, Aptorum, Arbutus, Hepion, Intellia, Janssen, Gilead, GSK, GRAIL, Medimmune, Merck, Roche, Vaccitech, VenatoRx, Vir Biotechnology; and a speaker for Mylan, Gilead and Roche. DS-CH has served as an advisory committee member for Roche. GL-HW has served as an advisory committee member for Gilead Sciences, as a speaker for Abbott, Abbvie, Bristol-Myers Squibb, Echosens, Furui, Gilead Sciences, Janssen and Roche, and received research grant from Gilead Sciences.

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