Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2021; 13(9): 1181-1189
Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1181
Elevated liver enzymes portends a higher rate of complication and death in SARS-CoV-2
Emily E Currier, Mohamad Dabaja, Syed-Mohammed Jafri
Emily E Currier, School of Medicine, Wayne State University, Detroit, MI 48201, United States
Mohamad Dabaja, Syed-Mohammed Jafri, Department of Gastroenterology, Henry Ford Hospital, Detroit, MI 48202, United States
Author contributions: Currier EE and Jafri SM designed the research study and performed the research; Currier EE, Jafri SM, and Dabaja M analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Henry Ford Hospital Institutional Review Board (Approval No. 13949).
Informed consent statement: The Informed consent statement was waived by the Institutional Review Board.
Conflict-of-interest statement: None of the authors have any conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emily E Currier, BSc, Doctor, School of Medicine, Wayne State University, 540 E. Canfield, Detroit, MI 48201, United States. emily.currier@med.wayne.edu
Received: April 20, 2021
Peer-review started: April 20, 2021
First decision: June 17, 2021
Revised: June 25, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: September 27, 2021
Abstract
BACKGROUND

Severe acute respiratory syndrome coronavirus 2, or coronavirus disease-2019 (COVID-19), has infected millions worldwide since its discovery in Wuhan, China in December 2019, but little is still known about the disease process. Preliminary research in China notes liver function tests (LFTs) abnormalities are common in COVID-19 patients, suggesting decreased hepatic function, and that abnormalities in LFTs are related to complicated disease course and negative outcomes. However, there has been limited large-scale data assessing COVID-19’s association with liver dysfunction and negative outcomes.

AIM

To investigate how COVID-19 affects the liver function and disease course in patients infected with the virus treated at Henry Ford Hospital from March to September 2020.

METHODS

A total of 8028 patients infected with COVID-19 were identified and included in the study at a single academic center. Data from medical charts on laboratory testing including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), and bilirubin levels, past history of liver disease, and disease course indicators including hospital admission, intensive care unit (ICU) admission, intubation, and death were recorded and analyzed. Elevated liver enzymes were defined as ALT/AST greater than 60, AP greater than 150, or bilirubin greater than 1.5, super-elevated liver enzymes were defined as ALT/AST greater than 120, AP greater than 300, or bilirubin greater than 3.0.

RESULTS

A total of 8028 COVID-19 patients were identified and included in the study. Data from medical charts on LFTs (namely, AST, ALT, AP, and bilirubin levels), past history of liver disease, and disease course indicators (hospital/ICU admission, intubation, death) were recorded and analyzed. LFTs from 3937 patients were available for interpretation. 45% were found to have elevated or super-elevated LFT. When compared to COVID-19 patients without elevated LFTs, this cohort was found to have significantly higher odds of hospital admittance, ICU admission, intubation, and death (all P < 0.001). 248 (3.1%) had a history of liver disease. Those with elevated and super elevated LFTS had significantly higher odds of having a past history of liver disease (P < 0.001).

CONCLUSION

The findings from this study suggest that in patients who have tested positive for COVID-19, those with elevated and super elevated liver enzyme levels have significantly higher odds of hospital admittance, ICU admittance, intubation and death in comparison to those COVID-19 patients without elevated liver enzyme levels.

Keywords: COVID-19, Hepatology, Liver damage, Complications, Elevated liver function test

Core Tip: This study suggests that in coronavirus disease-2019 (COVID-19) positive patients, those with elevated and super elevated liver function tests (LFTs) have significantly higher odds of hospital admittance, intensive care unit admittance, intubation, and death in comparison to those COVID-19 patients without elevated LFTs (all P < 0.001). LFT elevations may serve as an indicator for medical professionals in the treatment of COVID-19 patients and may allow for proactive treatment of those patients at increased risk of complications.