key: cord-0960045-ojf4olfd
authors: Wu, Yanyan; Ma, Zhuang; Guo, Xiaozhong; Li, Hongyu; Tang, Yufu; Meng, Hao; Yu, Hao; Peng, Chengfei; Chu, Guiyang; Wang, Xinwei; Teng, Yue; Zhang, Quanyu; Zhu, Tianyi; Wang, Bing; Tong, Zhenhua; Feng, Ruirui; Zhao, Haitao; Lu, Hui; Qi, Xingshun
title: Characteristics and In-Hospital Outcomes of COVID-19 Patients with Abnormal Liver Biochemical Tests
date: 2021-04-20
journal: Ann Hepatol
DOI: 10.1016/j.aohep.2021.100349
sha: daf29ac21bd8577dcc55a9ba3c13f54f7a15b0a2
doc_id: 960045
cord_uid: ojf4olfd

nan

We read with interest the article by Mendizabal et al. [1] mainly evaluated the association of abnormal liver tests at admission with clinical outcomes in Coronavirus disease 2019 (COVID-19) patients.

COVID-19 mainly leads to acute respiratory symptoms, including fever, dry cough, and dyspnea.

Besides, 16-76% of COVID-19 patients manifest as varying degrees of abnormal liver biochemistry tests [2] [3] [4] , which are secondary to viral infection of liver cells, liver hypoxia, drug-induced liver injury, and immune-inflammatory reaction [5, 6] . Notably, a minority of them may progress into liver failure [7] .

Some studies suggested that abnormal liver biochemical tests, especially elevated aspartate aminotransferase (AST), be closely associated with severe outcome [2, 8] and death [9, 10] in COVID-19 patients. Contrarily, others indicated no significant correlation of abnormal liver biochemical tests with mortality [11] or disease severity [12] . The current study aimed to explore the incidence and outcomes of abnormal liver biochemical tests in a large cohort of COVID-19 patients. 

Program published by the National Health Commission of China. Severity of COVID-19 patients was classified into mild, moderate, severe or critical [13] .

Liver biochemical abnormality was defined as at least one of liver-related biochemical tests exceeding At admission, 76.5% (1594/2083) of patients had abnormal liver biochemical tests, of which abnormal ALB was the most common, followed by GGT, ALT, AST, ALP, and TBIL (65.1%, 20.4%, 14.8%, 4.4%, 3.5%, and 2.5%). Abnormal liver biochemical tests at admission were significantly associated with disease progression (p=0.01), ICU (p=0.002), mechanical ventilation (p<0.001), death (p=0.01), and composite endpoint (p<0.001) ( Figure 1A) .

During hospitalization, 89.4% (1463/1637) of patients had abnormal liver biochemical tests, of which abnormal ALB was the most common, followed by GGT, ALT, AST, ALP, and TBIL (83.9%, 30.5%, 29.6%, 10%, 7.9%, and 3.5%). Abnormal liver biochemical tests during hospitalization were significantly associated with disease progression (p=0.013), ICU (p=0.04), mechanical ventilation (p=0.006), death (p=0.006), and composite endpoint (p=0.001) ( Figure 1B) .

The present study showed that liver biochemical abnormality was common in COVID-19 patients, especially during hospitalization. Except for the infection of this virus itself and disease progression, it may be partly due to the use of multiple drugs, such as empirical antibiotics or antiviral therapy, which are potentially hepatotoxic. The present study also indicated that patients with liver biochemical abnormality were at an increased risk of poor prognosis. Therefore, liver biochemistry in COVID-19 patients should be screened at admission and intensely monitored and managed during hospitalization.

A limitation should be acknowledged that severe or critical COVID-19 patients are more likely to have repeated laboratory tests and diagnose with liver injury. In future, prospective studies are needed to explore whether the management of abnormal liver biochemical indicators will influence the patients' outcomes.

J o u r n a l P r e -p r o o f 

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission

The liver in times of COVID-19: What hepatologists should know

Involvement of liver in COVID-19: systematic review and meta-analysis

Clinical Features of COVID-19-Related Liver Functional Abnormality. Clinical gastroenterology and hepatology : the official clinical practice journal of the

COVID 19 and liver: An A-Z literature review. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the

Systemic inflammation as fuel for acute liver injury in COVID-19. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the

Severe liver failure during SARS-CoV-2 infection

Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis

Prognostic value of liver biochemical parameters for COVID-19 mortality

The effect of liver test abnormalities on the prognosis of COVID-19

Liver involvement is not associated with mortality: results from a large cohort of SARS-CoV-2-positive patients

Liver tests abnormalities in COVID-19: trick or treat

General Office of National Health Commission of the people's Republic of China. Diagnosis and treatment of corona virus disease-19

We are indebted to all of the medical staffs who volunteered to participate in the treatment of COVID-19 patients at the Wuhan Huoshenshan Hospital. We would like to appreciate our study team for collecting the data of COVID-19 patients, including Yang An, Li Luo, Yiyan Zhang, Haijuan, Yao, Fangfang Yi, and Hongxin Chen.