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Reuters Health Information: Abnormal liver test results common in COVID-19

Abnormal liver test results common in COVID-19

Last Updated: 2020-04-23

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with COVID-19 commonly have abnormal liver test results, researchers in China report.

Several studies of the clinical characteristics of COVID-19 have reported elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and at least one study reported liver damage likely associated with SARS-CoV-2 infection.

In the current study, Dr. Lin Xu of Sun Yat-Sen University, in Guangzhou, and colleagues examined the clinical course and liver-test results in 417 COVID-19 patients admitted to the Third People's Hospital of Shenzhen.

Of these 417 patients, 318 (76.3%) had abnormal liver tests and 90 (21.5%) had liver injury (defined as ALT and/or AST over three times the upper limit of normal and alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and/or total bilirubin over two times the upper limit of normal) during their hospitalization.

At admission, about half of the patients had abnormal liver tests and 5% had liver injury. Fewer than 4% had abnormal liver tests higher than two times the upper limit of normal.

The presence of liver-test abnormalities became more pronounced during hospitalization, and 26.7% of patients with abnormal liver tests progressed to severe pneumonia.

Among the 90 patients with liver injury during hospitalization, about half were severe cases, the researchers report in the Journal of Hepatology.

After adjustment for age, sex, liver comorbidities and other factors, having abnormal liver tests were not associated with disease severity, but patients with liver injury had 9.04-fold higher odds of severe COVID-19 (P<0.001).

Except for lopinavir/ritonavir, there was no evidence that the use of drugs previously associated with liver dysfunction had an increased risk for liver injury.

"The liver test abnormality rate in our study was higher than previously reported and only a small portion had underlying liver disease, suggesting that liver damage in patients with coronavirus infection might be directly caused by the viral infection of liver cells," the authors conclude.

Dr. Mansoor Bangash of the University of Birmingham, in the UK, who recently summarized liver-test abnormalities from various COVID-19 studies, told Reuters Health by email, "Liver test abnormalities are common in COVID-19; in isolation (they) probably won't have sufficient discriminating power to allow prognostication, but might indicate more attention to drug interactions and adverse effects is needed."

"Patients with underlying liver diseases are more likely to have abnormal liver tests on presentation, suggesting their livers are more vulnerable to damage," he said. "Therefore, patients with pre-existing liver diseases are at greater risk of COVID-19-induced liver-test abnormalities, and clinicians should be mindful of this in their advice to and treatment of these patients."

He added, "Although only one patient was biopsied, liver tissue did not support direct viral damage as a cause of liver injury. This could mean that viral replication in cholangiocytes has less clinical relevance for liver injury than previously thought, and that iatrogenic harm from drug therapies and illness severity are more important considerations."

Dr. Xu and co-authors Dr. Jun Chen and Dr. Lei Liu did not respond to a request for comments.

SOURCE: Journal of Hepatology, online April 13, 2020.

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