Clinical Significance of Liver Function Abnormality in Patients with COVID-19: A Single-center Experience from Western India

Chetan R Kalal; Harshad Joshi; Vivek Kumar; Divya Gopal; Darshana Rathod; Ashish Shukla; Tarang Gianchandani; Chetan Bhatt

doi:10.14218/JCTH.2020.00099

Clinical Significance of Liver Function Abnormality in Patients with COVID-19: A Single-center Experience from Western India

J Clin Transl Hepatol. 2021 Dec 28;9(6):878-888. doi: 10.14218/JCTH.2020.00099. Epub 2021 May 13.

Authors

Chetan R Kalal¹, Harshad Joshi¹, Vivek Kumar², Divya Gopal², Darshana Rathod², Ashish Shukla², Tarang Gianchandani³, Chetan Bhatt¹

Affiliations

¹ Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.
² Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.
³ Department of Administration, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.

Abstract

Background and aims: The impact of coronavirus disease-2019 (COVID-19) on liver function remains to be fully elucidated. This study was designed to investigate such and determine the clinical significance in determining mortality risk.

Methods: A retrospective study was conducted in patients with COVID-19 from March 2020 to July 2020. Clinical details were retrieved from electronic medical records to obtain clinical characteristics, medical history, laboratory tests, therapeutic intervention, and outcome data.

Results: A total of 184 patients with COVID-19 were included (median age: 45.5 years), comprised of 62.5% men. In total, 22 (12.0%) patients had severe infection and 162 (88.0%) had mild to moderate infection. Overall, 95 (51.6%) showed abnormal liver function test (LFT) and 17 (9.2%) showed normal LFT at admission. The median age, hospital stay, and LFT were significantly higher in severe vs. non-severe infection (p<0.001). Out of 12 deaths, the majority were due to severe infection (n=11). Deaths were also due to acute respiratory distress syndrome (n=5), cardiac reasons (n=3), and sepsis with multiorgan failure (n=3). The median age, hospital stay and number of intensive care unit admissions were higher in patients having abnormal LFT compared to normal LFT. Incidence of elevated aspartate aminotransferase (42.8% and 40.4%), alanine transaminase (43.7% and 41.6%), and hypoalbuminemia (71.4% and72.7%) at admission and discharge were more common in severe infection. The mean survival was significantly lower in severe infection compared to those with non-severe disease (17.2 vs. 52.3 days; p<0.001).

Conclusions: Incidence of abnormal liver function was higher in patients with severe COVID-19 and was associated with prolonged hospital stay; mortality was associated with severity of COVID-19. For ruling out the risk of liver injury, it is crucial to vigilantly monitor the liver function parameters in patients with COVID-19 admitted to hospital.

Keywords: ALT/AST; Hospital stay; Hypoalbuminemia; Liver injury; Severe disease.