Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19

• Published in: Gut Vol. 70; no. 4; pp. 733 - 742
• Main Authors: Yip, Terry Cheuk-Fung, Lui, Grace Chung-Yan, Wong, Vincent Wai-Sun, Chow, Viola Chi-Ying, Ho, Tracy Hang-Yee, Li, Timothy Chun-Man, Tse, Yee-Kit, Hui, David Shu-Cheong, Chan, Henry Lik-Yuen, Wong, Grace Lai-Hung
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 01.04.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adult; Age; Alanine; Alanine transaminase; Alanine Transaminase - blood; Antibiotics; Antiretroviral drugs; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Aspartate aminotransferase; Aspartate Aminotransferases - blood; Bile; cholestasis; Clinical outcomes; Codes; Coronaviridae; Coronaviruses; Corticosteroids; COVID-19; COVID-19 - blood; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - drug therapy; Diabetes; Diabetes mellitus; Disease; Drug Combinations; Female; Gallbladder diseases; Hepatitis; Hepatology; Hong Kong - epidemiology; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypertension; Infections; Interferon; Laboratories; Liver; Liver - drug effects; Liver - virology; liver function test; Liver Function Tests - methods; Liver Function Tests - statistics & numerical data; Lopinavir; Lopinavir - administration & dosage; Lopinavir - adverse effects; Male; Mechanical ventilation; Middle East respiratory syndrome; Respiratory diseases; Retrospective Studies; Ribavirin; Ribavirin - administration & dosage; Ribavirin - adverse effects; Ritonavir; Ritonavir - administration & dosage; Ritonavir - adverse effects; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Ventilators; Hong Kong; Hong Kong China; China; hepatitis; cholestasis; liver function test
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2020-321726

ObjectiveData on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear.DesignThis was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death.ResultsWe identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir–ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation.ConclusionALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir–ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.