Acute Liver Injury in Patients Hospitalized with COVID-19. Dig Dis Sci 2022 Aug;67(8):4204-4214
Date
09/07/2021Pubmed ID
34487314Pubmed Central ID
PMC8419385DOI
10.1007/s10620-021-07230-9Scopus ID
2-s2.0-85114446135 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
INTRODUCTION: The prevalence and significance of acute liver injury in patients with COVID-19 are poorly characterized.
METHODS: Patients with confirmed COVID-19 who were hospitalized in geographically diverse medical centers in North America were included. Demographics, symptoms, laboratory data results, and outcomes were recorded. Linear and logistic regression identified factors associated with liver injury, in-hospital mortality, and length of stay (LOS).
RESULTS: Among 1555 patients in the cohort, most (74%) had an elevated alanine aminotransferase (ALT) during hospitalization, which was very severe (> 20 × upper limit of normal [ULN]) in 3%. Severe acute liver injury (ALI) was uncommon, occurring in 0.1% on admission and 2% during hospitalization. No patient developed acute liver failure (ALF). Higher ALT was associated with leukocytosis (per mL3) (β 10.0, 95% confidence interval (CI) 6.7-12.6, p < 0.001) and vasopressors use (β 80.2, 95%CI 21.5-138.8, p = 0.007). In-hospital mortality was associated with ALT > 20 × ULN (unadjusted OR 6.0, 95%CI 3.1-11.5, p < 0.001), ALP > 3 × ULN (unadjusted OR 4.4, 95%CI 2.5-7.7, p < 0.001), and severe ALI (unadjusted OR 6.8, 95%CI 3.0-15.3, p < 0.001) but lost significance after adjusting for covariates related to severe COVID-19 and hemodynamic instability. Elevated ALP and ALT were associated with longer LOS, admission to intensive care, mechanical ventilation, vasopressor use, and extracorporeal membrane oxygenation use (p < 0.001).
CONCLUSIONS: Transaminase elevation is common in hospitalized patients with COVID-19. Severe ALI is rare, and ALF may not be a complication of COVID-19. Extreme elevations in liver enzymes appear to be associated with mortality and longer LOS due to more severe systemic disease rather than SARS-CoV-2-related hepatitis.
Author List
Sobotka LA, Esteban J, Volk ML, Elmunzer BJ, Rockey DC, North American Alliance for the Study of Digestive Manifestation of COVID-19*Author
James Esteban MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Alanine TransaminaseHospitalization
Humans
Liver
Liver Failure, Acute
Retrospective Studies