Evaluation of liver function in symptomatic COVID-19 patients

Abstract

CONTEXT: The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14-53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction. AIMS: Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients. SETTINGS AND DESIGN: This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal. METHODS AND MATERIAL: The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value. RESULTS: From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died. CONCLUSIONS: Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.