The clinical implication of gamma-glutamyl transpeptidase in COVID-19

Jianrong Liu; Chao Yu; Qing Yang; Xiaofeng Yuan; Fan Yang; Panlong Li; Guihua Chen; Weicheng Liang; Yang Yang

doi:10.1016/j.livres.2021.09.001

The clinical implication of gamma-glutamyl transpeptidase in COVID-19

Liver Res. 2021 Dec;5(4):209-216. doi: 10.1016/j.livres.2021.09.001. Epub 2021 Sep 25.

Authors

Jianrong Liu^{1

2}, Chao Yu^{3

4}, Qing Yang^{1

5}, Xiaofeng Yuan^{1

2}, Fan Yang^{6

7

8}, Panlong Li^{3

6}, Guihua Chen^{1

9

10}, Weicheng Liang^{3

6}, Yang Yang^{1

9

10}

Affiliations

¹ Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Surgical and Transplant Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁴ Medical Examination Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁵ Organ Transplantation Research Center of Guangdong Province, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁶ Biotherapy Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁷ Department of Infectious Diseases, The People's Hospital of Kashgar, Kashgar, Xinjiang, China.
⁸ Department of Infectious Diseases, Xinjiang Medical University, Urumqi, China.
⁹ Organ Transplantation Institute of Sun Yat-sen University, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
¹⁰ Guangdong Province Engineering Laboratory for Transplantation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

Background and aim: Coronavirus disease 2019 (COVID-19) is a life-threatening disease that predominantly causes respiratory failure. The impact of COVID-19 on other organs remains elusive. Herein, we aimed to investigate the effects of COVID-19 on the hepatobiliary system.

Methods: In the current study, we obtained the clinical records and laboratory results from 66 laboratory-confirmed patients with COVID-19 at the Wuhan Tongji Hospital between 10 February 2020 and 28 February 2020. The detailed clinical features and laboratory findings were collected for analysis. Bioinformatics analysis was conducted to evaluate the correlation between gamma-glutamyl transferase (GGT) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry receptor angiotensin-converting enzyme 2 (ACE2).

Results: In this cohort, 30 (51.7%) patients had abnormal liver function on admission, which was associated with disease severity and enriched in the male and diabetic patients. The elevated levels of direct bilirubin (P = 0.029) and GGT (P = 0.004) were common in patients with severe pneumonia when compared with those with mild pneumonia. In addition, elevated levels of GGT (P = 0.003) and aspartate aminotransferase (AST) (P = 0.007) were positively associated with longer hospital stay. The expression of ACE2 was closely associated with GGT in various human tissues because they shared the common transcriptional regulator hepatic nuclear factor-1β (HNF1B).

Conclusions: Increased GGT levels were common in severe cases and elevated GGT levels were positively associated with prolonged hospital stay and disease severity. Due to the consistent expression with ACE2, GGT is a potent biomarker indicating the susceptibility of SARS-CoV-2 infection.

Keywords: Angiotensin-converting enzyme 2 (ACE2); Bile duct injury; Coronavirus disease 2019 (COVID-19); Gamma-glutamyl transpeptidase (GGT); Liver injury; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).