key: cord-0873088-tkg5r76w
authors: Ye, Zheng; Song, Bin
title: Liver injury in COVID‐19: Diagnosis and associated factors
date: 2020-05-14
journal: Liver Int
DOI: 10.1111/liv.14501
sha: 9f3af6c731f7167f30c37d093ba47f16df38765e
doc_id: 873088
cord_uid: tkg5r76w

We read with interest the study by Xie et al. about the liver injury in non-ICU hospitalized COVID-19 patients1 ; the authors found liver injury was prevalent in COVID-19 patients and might associate with CT scores. However, we believe some concerns should be aroused regarding this conclusion.

We read with interest the study by Xie et al about the liver injury in non-ICU hospitalized COVID-19 patients 1 ; the authors found liver injury was prevalent in COVID-19 patients and might associate with CT scores. However, we believe some concerns should be aroused regarding this conclusion.

Liver function abnormalities were frequent in COVID-19 patients, especially the severe cases. 2 However, as a new contagious disease, there is no standardized diagnostic criteria of COVID-19associated liver injury at present. Some researchers defined liver injury as any liver function parameter above the upper limit of normal (ULN), 3 but others defined it as liver enzymes higher than two or three times of ULN, and even further classified different liver injury patterns. 4 This study defined elevated levels of alanine transaminase (ALT), aspartate aminotransferase (AST) or bilirubin as liver injury without specifying the ULN of laboratory reference, which was ambiguous and made it difficult to replicate their results. Another important finding in this study was that severe lung lesions on CT (i.e. high CT score) might be related to higher incidence of liver injury. However, the CT scores were assigned on the basis of the percentage of involved lung area, which was semi-quantitative and subjective. Quantification of lung involvements with advanced CT post-processing software or AI algorithms may be more accurate and reproducible. 5 Moreover, although CT score was suggested an independent predictor for liver injury in COVID-19 patients, it remains unclear that how many variables were included in the logistic regression and whether the CT score was the only significant predictor.

In summary, this study provided interesting but preliminary findings. Large-sample multicentre studies are needed to validate these results and further explore COVID-19-associated liver injury. 

Clinical characteristics of non-ICU hospitalized patients with coronavirus disease 2019 and liver injury: A retrospective study

Liver injury during highly pathogenic human coronavirus infections

Clinical features of COVID-19-related liver damage

Characteristics of liver tests in COVID-19 patients

Quantitative computed tomography analysis for stratifying the severity of Coronavirus Disease