The association between markers of liver injury and clinical outcomes in patients with COVID-19 in Wuhan

Abstract

Background: The outbreak of coronavirus disease 2019 (COVID-19) is a critical challenge for public health. The effect of COVID-19 on liver injury has not been fully established.

Aims: To evaluate the dynamic changes in liver function and the relationship between liver damage and prognosis in patients with COVID-19.

Methods: Retrospective analysis of clinical data of 675 patients with COVID-19 in Zhongnan Hospital of Wuhan University from January 3 to March 8, 2020. Patients were classified as having normal or abnormal liver function and liver injury.

Results: Of 675 patients, 253 (37.5%) had abnormal liver function during hospitalisation, and 52 (7.7%) had liver injury. The dynamic changes of ALT and AST levels were more significant in patients with liver injury and in those who died. AST >3-fold upper limit of normal (ULN) had the highest risk of death and mechanical ventilation. Compared to patients with normal AST levels, mortality and risk of mechanical ventilation significantly increased 19.27-fold (95% confidence interval [CI], 4.89-75.97; P < 0.0001) and 116.72-fold (95% CI, 31.58-431.46; P < 0.0001), respectively, in patients with AST above 3-fold ULN. Increased leucocytes, decreased lymphocytes and female sex were independently associated with liver injury.

Conclusions: The dynamic changes in liver function may have a significant correlation with the severity and prognosis of COVID-19. Increased index of liver injury was closely related to mortality and need for mechanical ventilation. Therefore, these indicators should be closely monitored during hospitalisation.

FIGURE 1

Flow diagram of the exclusion criteria. COVID‐19, coronavirus disease 2019

FIGURE 2

Smooth trajectories and scatter represent the median values (A) ALT; (B) AST; and (C) TBIL in the normal liver function, abnormal liver function and liver injury groups

FIGURE 3

Smooth trajectories and scatter represent the median values (A) ALT; (B) AST; and (C) TBIL in the fatal and nonfatal groups

FIGURE 4

Kaplan‐Meier curves for survival probability of COVID‐19 during hospitalisation in patients with different levels of (A) ALT, (B) AST and (C) TBIL. ALT 0: ALT ≤40 U/L; ALT 1: 40‐120 U/L; ALT 2: ≥120 U/L. AST 0: AST ≤40 U/L; AST 1: 40‐120 U/L; AST 2: ≥120 U/L. TBIL 0: ≤21 μmol/L; TBIL 1: 21‐63 μmol/L; TBIL 2: ≥63 μmol/L. 0*: ALT or AST or TBIL ≤ ULN; 1*: ALT or AST or TBIL: ULN‐3ULN; 2*: ALT or AST or TBIL ≥ 3ULN

FIGURE 5

Kaplan‐Meier curves for mechanical ventilation‐free survival probability during hospitalisation in patients with different levels of (A) ALT, (B) AST and (C) TBIL. ALT 0: ALT ≤40 U/L; ALT 1: 40‐120 U/L; ALT 2: ≥120 U/L. AST 0: AST ≤40 U/L; AST 1: 40‐120 U/L; AST 2: ≥120 U/L. TBIL 0: ≤21 μmol/L; TBIL 1: 21‐63 μmol/L; TBIL 2: ≥63 μmol/L. 0*: ALT or AST or TBIL ≤ ULN; 1*: ALT or AST or TBIL: ULN‐3ULN; 2*: ALT or AST or TBIL ≥ 3ULN