Clinical features and risk factors of COVID-19-associated liver injury and function: A retrospective analysis of 830 cases

Abstract

Introduction and objectives: The incidence of liver injury (LI) in hospitalized COVID-19 patients ranged from 14% to 53% based on sole or multiple elevated indexes for LI. The aims of our study were to investigate the changes of parameters (ALT, AST) in LI and determine the risk factors for LI in a cohort of 830 COVID-19 patients.

Methods: Demographic information, clinical features, and laboratory testing outcomes on admission were compared between patients with and without liver biochemistry abnormality (LBA). The same comparisons were performed between the LBA and LI groups. The updated RUCAM was used to determine the causality between drugs application and LI. Univariable and multivariable logistic regression analyses were used to explore the potential risk factors associated with LBA and LI.

Results: A total of 227 (27.3%) patients exhibited LBA and 32 (3.9%) patients were categorized as having LI based on the diagnostic criteria. 32.6% (74/227) of the LBA patients had RUCAM score >3, whereas the non-LBA patients had a slight lower at rate of 24.2% (146/603) (P?=?0.047). Multivariable regression showed that a higher incidence of LBA was associated with hepatic hypoattenuation on computed tomography (CT) (odds ratio: 2.243, 95% confidence interval: 1.410-3.592, p?=?0.001), lymphocyte proportion <20% (2.088, 1.476-2.954, p?<?0.001), C-reactive protein (CRP) >1?mg/dL (2.650, 1.845-3.806, p?<?0.001) and aspartate transaminase to alanine transaminase (AST/ALT) ratio >1 (2.558, 1.820-3.596, p?<?0.001).

Conclusions: CRP levels >1.0?mg/dL, lymphocyte proportion <20%, AST/ALT ratio <1, and triglyceride levels >1.7?mol/L are potential risk factors for LI.

Keywords: Betacoronavirus; Drug induced liver injury; Hepatic insufficiency; Pneumonia; Tomography; X-ray.

Fig. 1

A 39-year-old man with COVID-19 pneumonia. Changes in liver attenuation on serial chest CT examinations. (A) a section of the liver shows hypoattenuation (mean attenuation: 34.4 HU) in the liver parenchyma on initial chest CT scan (obtained on day 4 after the onset of symptoms); (B) a section of the liver shows an increase in liver attenuation (mean attenuation: 48.8 HU) on the second chest CT (day 10 after the onset of symptoms); (C) a section of the liver shows continued recovery in liver attenuation (mean attenuation: 54.0 HU) on the third chest CT scan (day 15 after the onset of symptoms); (D) initial chest CT scan shows multifocal patchy ground-glass opacities (GGO) in two lungs; (E) the second chest CT image shows dissipation of GGO in the left lower lobe and a mild enlargement of GGO in the right lower lobe; (F) the third chest CT image shows demonstrative absorption.

Fig. 2

Mechanism of liver injury in patients with coronavirus disease 2019 (COVID-19).

Fig. 3

(A) ROC curve for multivariable logistic regression model in predicting LBA with the AUC. (B) ROC curve analysis of multivariable logistic regression model in predicting LI.