Dynamic monitoring of serum liver function indexes in patients with COVID-19

Abstract

Background: Some patients with the novel 2019 coronavirus disease (COVID-19) display elevated liver enzymes. Some antiviral drugs that can be used against COVID-19 are associated with a risk of hepatotoxicity.

Aim: To analyze the clinical significance of the dynamic monitoring of the liver function of patients with COVID-19.

Methods: This was a retrospective study of patients diagnosed with COVID-19 in January and February 2020 at the Department of Infection, Shantou Central Hospital. The exclusion criteria for all patients were: (1) History of chronic liver disease; (2) History of kidney disease; (3) History of coronary heart disease; (4) History of malignancy; or (5) History of diabetes. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase, and total bilirubin of patients with COVID-19 were measured on days 1, 3, 7 and 14 after admission, and compared to non-COVID-19 patents.

Results: Twelve patients with COVID-19 (seven men and five women) and twelve controls (eight men and four women) were included. There were one, two, and nine patients with severe, mild, and moderate COVID-19, respectively. There were no differences in age and sex between the two groups (both P > 0.05). No significant differences were found in albumin, ALT, AST, γ-glutamyltransferase, or total bilirubin between the controls and the patients with COVID-19 on day 1 of hospitalization (all P > 0.05). Serum albumin showed a decreasing trend from days 0 to 7 of hospitalization, reaching the lowest level on day 7. Total bilirubin was higher on day 3 than on day 7. ALT, AST, and γ-glutamyltransferase did not change significantly over time. The severe patient was observed to have ALT levels of 67 U/L and AST levels of 75 U/L on day 7, ALT of 71 U/L and AST of 35 U/L on day 14, and ALT of 210 U/L and AST of 123 U/L on day 21.

Conclusion: Changes in serum liver function indicators are not obvious in the early stage of COVID-19, but clinically significant changes might be observed in severe COVID-19.

Keywords: COVID-19; Disease severity; Dynamic monitoring; Index; Kidney disease; Liver function.

Figure 1

Liver function indexes. The control group was compared with Day 1 group by Student t-test. Different time of disease group using analysis of variance and the LSD post hoc test. Data are shown as mean ± standard deviation, n = 12. ^aP < 0.01, ^bP < 0.001. Con: Control group; Day 1-Day 14: Disease group. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DBIL: Direct bilirubin; GGT: γ-glutamyltransferase; TBIL: Total bilirubin.