Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients

Mil Med Res. 2020 Jun 7;7(1):28. doi: 10.1186/s40779-020-00256-6.

Abstract

Background: Recent studies reported that patients with coronavirus disease-2019 (COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) have been shown.

Methods: This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group (n = 79) and severe group(n = 26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined.

Results: 56.2% (59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4% (96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range (ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group (P < 0.05). The percentage of the patients with elevated both ALT and AST was 12.7% (10/79) in mild cases vs. 46.2% (12/26) in severe cases (P = 0.001). 34.6% (9/26) severe group patients started to have abnormal ALT after admission, and 73.3% (77/105) of all patients had normal ALT before discharge.

Conclusions: Elevated liver function index is very common in patients with COVID-19 infection, and the level were less than 3 × ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.

Keywords: Coronavirus disease-2019; Dynamic change; Liver function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alanine Transaminase / blood*
  • Aspartate Aminotransferases / blood
  • Betacoronavirus*
  • Bilirubin / blood
  • Biomarkers / blood
  • COVID-19
  • Coronavirus Infections / blood*
  • Coronavirus Infections / complications
  • Coronavirus Infections / virology
  • Female
  • Hepatitis, Viral, Human / blood*
  • Hepatitis, Viral, Human / virology*
  • Humans
  • Liver / physiopathology
  • Liver / virology*
  • Liver Function Tests
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / virology
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index
  • Young Adult

Substances

  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin