Clinical, biochemical and pulmonary CT imaging features for hepatobiliary involvement in COVID-19

Eduard Dumea; Ecaterina Constanţa Barbu; Cristina Emilia Chiţu; Mihai Lazăr; Daniela Adriana Ion

doi:10.18683/germs.2023.1375

Clinical, biochemical and pulmonary CT imaging features for hepatobiliary involvement in COVID-19

Germs. 2023 Jun 30;13(2):121-129. doi: 10.18683/germs.2023.1375. eCollection 2023 Jun.

Authors

Eduard Dumea¹, Ecaterina Constanţa Barbu², Cristina Emilia Chiţu², Mihai Lazăr³, Daniela Adriana Ion⁴

Affiliations

¹ MD, PhD student, Department of Pathophysiology, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Bucharest, Romania.
² MD, PhD, Department of Pathophysiology, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Bucharest, Romania.
³ MD, PhD, Department of Pathophysiology, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Bucharest, Romania, and Department of Radiology and Medical Imaging, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 1 Dr. Calistrat Grozovici Street, Bucharest 021105, Romania.
⁴ MD, PhD, Department of Pathophysiology, Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, 37 Dionisie Lupu Street, Bucharest Romania.

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a viral disease with primary pulmonary involvement and systemic impact. This article aims to assess the importance of clinical, biological, demographic and radioimaging parameters in COVID-19 patients in characterizing the incidence and severity of the hepatobiliary involvement.

Methods: We performed an observational cohort study on 132 consecutive patients, evaluating their demographics, hospitalization period, peripheral oxygen saturation (SpO₂) in the ambient air, as well as biochemical markers of hepatobiliary involvement: aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB), gamma-glutamyl transferase (GGT), serum albumin, total serum proteins, D-dimers; coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR); inflammatory markers: fibrinogen, serum ferritin, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis alpha (TNF-α). Hepatobiliary involvement was further stratified by type of affection pattern: hepatocytolysis, cholestasis or mixed type. All patients received a computerized tomography (CT) chest scan in the first or second day of hospital admission.

Results: We observed lower SaO₂ and longer hospitalization days in patients with hepatobiliary involvement, as well as longer coagulation times (PT and INR), lower serum albumin and higher serum ferritin (p<0.05). No significant correlations have been found between the degree or type of pattern of lung involvement as seen on CT scans performed and biochemical liver changes.

Conclusions: Hepatobiliary involvement occurred in 72% of patients in the study group, associated with longer hospitalization period, prolonged coagulation parameters, lower serum albumin levels, raised serum ferritin and CRP levels. Cholestatic and mixed types of injury were associated with higher ferritin levels, while mixed type alone presented higher D-dimers levels compared with the cholestatic or hepatocytolysis groups. No significant correlation was found between lung involvement by CT evaluation and hepatobiliary involvement.

Keywords: COVID-19; SARS-CoV-2; cholestasis; hepatic cytolysis; liver involvement.

GERMS.