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Observational Study
. 2022 Sep;29(9):823-834.
doi: 10.1111/jvh.13718. Epub 2022 Jun 26.

Follow-up evaluation of patients with liver test abnormalities detected during SARS-CoV2 infection

Lidia Canillas  1   2 , Teresa Broquetas  1   2 , José A Carrión  1 , Giulia Pagano  1 , Agnès Soriano  1 , Esther Garrido  1   2 , Rosa Fernández  1   2 , Ana Viu  1   2 , Judit Romero  1   2 , Gemma Díaz  1   2 , Nuria Cañete  1   2 , Susana Coll  1   2 , Dolores Naranjo  3 , Xavier Bessa  1   2 , Montserrat Garcia-Retortillo  1   2 , Marc Puigvehí  1   2
Affiliations
Observational Study

Follow-up evaluation of patients with liver test abnormalities detected during SARS-CoV2 infection

Lidia Canillas et al. J Viral Hepat. 2022 Sep.

Abstract

Abnormal liver function tests (A-LFTs) during admission for coronavirus disease-19 (COVID-19) are frequent, but its evolution after COVID-19 resolution remains unexplored. We evaluated factors related to A-LFTs during COVID-19 and assessed the liver outcome after patients' discharge. This is a observational study including: (1) retrospective analysis of variables related to A-LFTs during COVID-19; and (2) follow-up evaluation with blood test, transient elastography and liver biopsy in those with persistent A-LFTs. A-LFTs were defined according to CTCAEv4.0. Among 595 patients, 366 (61.5%) showed A-LFTs. The ratio of partial pressure of oxygen and inspired oxygen fraction (P/F) below 200, ferritin ≥1000 ng/mL, male gender and antibiotic and immunomodulatory treatments were related to A-LFTs. Follow-up evaluation was performed in 153 individuals. Persistent A-LFTs at follow-up was similar in patients with/without A-LFTs during admission (14.1% vs. 4.9%, p = 0.104). Fifteen (93%) and 58 (39%) patients with/without A-LFTs at follow-up showed metabolic fatty liver disease criteria (p < 0.001), which were histologically confirmed. In conclusion, A-LFTs during COVID-19 were related to infection severity. Abnormalities remitted at follow-up in >80% of patients, and no correlation between A-LFTs at admission and at follow-up was found. Most patients with A-LFTs at follow-up had non-invasive and histologically proven fatty liver disease.

Keywords: COVID-19; SARS-CoV2; follow-up; liver function tests; metabolic-associated fatty liver disease (MAFLD).

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Conflict of interest statement

The authors declare no conflict of interest relevant to this work.

Figures

FIGURE 1
FIGURE 1
Study flow‐chart
FIGURE 2
FIGURE 2
Liver assessment at follow‐up. (A, B) Evolution of AST and ALT from peak value during COVID‐19 to follow‐up (median time 10 months). Median (IQR) peak AST and ALT was 52 (37–93) U/L and 60 (45–128) U/L. Median (IQR) AST and ALT at follow‐up was 20 (17–24) and 18 (14–26). (C, D) Distribution of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) values according to the presence or absence of LFTs abnormalities at follow‐up. Each violin plot represents the density curves, the median (white point), the interquartile range (box) and 95% confidence intervals (lines)
FIGURE 3
FIGURE 3
Non‐invasive diagnosis of liver disease in patients after the COVID‐19. Metabolic associated fatty liver disease (MAFLD) was defined as obesity (body mass index [BMI] ≥30 kg/m2) or diabetes or metabolic syndrome associated to CAP >300 db/m or CAP 250–300 db/m with radiologic evidence of steatosis. Alcohol‐related liver disease was considered if harmful alcohol consumption in the absence of metabolic dysfunction. Other liver chronic liver disease category includes primary biliary cholangitis, alpha‐1 antitrypsin deficiency and liver stasis associated to cardiac failure
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