Year 2021 / Volume 113 / Number 12
Original
Abnormal liver chemistry constitutes an independent prognostic factor of less favorable clinical course in patients with COVID-19

825-832

DOI: 10.17235/reed.2021.7842/2021

Carlos Alventosa Mateu, Juan José Urquijo Ponce, Francesc Puchades Gimeno, Salvador Benlloch Pérez, Francisco Sanz Herrero, Mercedes Latorre Sánchez, Miguel García Deltoro, Concepción Gimeno Cardona, María Dolores Ocete Mochón, Moisés Diago Madrid,

Abstract
Introduction: abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. The aim of this study was to determine whether ALB is a risk factor for unfavorable clinical outcome and involvement. Materials and methods: a retrospective, single-center study in confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as any elevation of total bilirubin, AST, ALT, alkaline phosphatase, and/or GGT above the upper limit of normal. First, an assessment was made of the correlation between ALB and need for hospitalization. This was followed by an assessment of the correlation of ALB in hospitalized patients with demographic variables, comorbidities, and treatment for COVID-19, and with clinical involvement and outcome. The statistical analysis was performed using an age-adjusted multiple logistic regression with a p-value < 0.05. Results: of 1,277 confirmed cases, 346 required hospitalization and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9 % vs. 10.3 %, p ˂ 0.001). Among hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities, or treatment for COVID-19, except for low molecular weight heparin. There was a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation of ALB with longer hospital stay and admission to the intensive care unit, but this did not imply increased mortality. Conclusions: ALB correlates with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.
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25/02/2022 14:09:11
AGRADECIDOS A LA SOCIEDADESPAÑOLA DE ENFERMEDADES DIGESTIVAS POR TAN LOABLE LABOR DIDACTICA, ACADEMICA
Dr. Cristóbal Betancourt Natera
Puerto Ordaz, VENEZUELA


References
1. https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/situacionActual.htm
2. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.
3. Fan Z, Chen L, Li J, et al. Clinical features of COVID-19 related liver damage. Clin Gastroenterol Hepatol 2020;18:1561-6.
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
5. Xu L, Liu J, Lu M, et al. Liver injury during highly pathogenic human coronavirus infections. Liver Int 2020;40:998-1004.
6. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: Management and challenges. Lancet Gastroenterol Hepatol 2020;5:428-30.
7. Tian S, Hu N, Lou J, et al. Characteristics of COVID-19 infection in Beijing. J Infect 2020;80:401-6.
8. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382;1708-20.
9. Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388-93.
10. Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hepatol 2020;73:566-74.
11. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13.
12. Bloom PP, Meyerowitz EA, Rinus Z, et al. Liver biochemistries in hospitalized patients with COVID-19. Hepatology 2021;73:890-900.
13. Lei F, Liu YM, Zhou F, et al. Longitudinal association between markers of liver injury and mortality in COVID-19 in China. Hepatology 2020;72:389-98.
14. Jothimani D, Venugopal R, Abedin MF, et al. COVID-19 and the liver. J Hepatol 2020;73:1231-40.
15. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2.
16. Wang Y, Liu S, Liu H, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. J Hepatol 2020;73:807-16.
17. Kulkarni AV, Kumar P, Tevethia HV, et al. Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19. Aliment Pharmacol Ther 2020;00:1-16.
18. Wynants L, Calster B Van, Collins GS, et al. Prediction models for diagnosis and prognosis of COVID-19 infection: systematic review and critical appraisal. BMJ 2020;369:m1328.
19. COVID-19 clinical management: living guidance. WHO; 2021. Disponible en: WHO-2019-nCoV-clinical-2021.1-eng.pdf.
20. Aithal GP, Watkins PB, Andrade RJ, et al. Case definition and phenotype standardization in grug-induced live injury. Clin Pharmacol Ther 2011;98:806-15.
21. http://who/2019-nCoV/clinical/2020.5
22. Olry A, Meunier L, Délire B, et al. Drug-Induced Liver injury and COVID-19 Infection: The rules remain the same. Drug Saf 2020;43:615-17.
23. Mehershahi S, Mantri N, Kumar A, et al. Enoxaparin-Induced liver injury. Gastroenterol 2020;14:315-9.
24. Wang H, Qiu P, Liu J, et al. The liver injury and gastrointestinal symptoms in patients with coronavirus disease 2019: A systematic review and meta-analysis. Clin Res Hepatol and Gastroenterol 2020;44:653-61.
25. Ahmed J, Rizwan T, Malik F, et al. COVID-19 and liver injury: a systematic review and meta-analysis. Cureus 2020;12:e9424.
26. Ghoda A, Ghoda M. Liver injury in COVID-19 infection: a systematic Review. Cureus 2020;12:e9487.
27. Wong WJ, Tan M, Zheng Q, et al. A systematic review and meta-analysis of the COVID-19 associated liver injury. Ann Hepatol 2020;19:627-34.
28. Kumar-MP, Mishra S, Jha DK, et al. Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis. Hepatol Int 2020;14:711-22.
29. Abdulla S, Hussain A, Azim D, et al. COVID-19-Induced Hepatic Injury: a systematic review and meta-analysis. Cureus 2020;12:e10923.
30. Mohammad P, Yaghoubi S, Seraj A. Liver injury is associated with severe Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of retrospective studies. Hepatol Res 2020;50:924-35.
31. Ampuero J, Sánchez Y, García-Lozano MD, et al. Impact of liver injury on the severity of COVID-19: a systematic review with meta-analysis. Rev Esp Enferm Dig 2021;113:125-35.
32. Cheng L, Li H, Li L, et al. Ferritin in the coronavirus 2019 (COVD-19): a systematic review and meta-analysis. J Clin Lab Anal 2020;34:e23618.
33. Sun Y, Dong Y, Wang L, et al. Characteristics and prognosis factors of disease severity in patients with COVID-19: the Beijing experience. J Autoinmun 2020;112:102473.
34. Weber S, Hellmuth JC, Scherer C, et al. Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: a prospective cohort study. Gut 2021;70(10):1925-32. DOI: 10.1136/gutjnl-2020-323800
35. Caballería LL, Pera G, Arteaga I, et al. High prevalence of liver fibrosis among european adults with unknown liver disease: a population-based study. Clinical Gastroenterol Hepatol 2018;16:1138-45.
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Alventosa Mateu C, Urquijo Ponce J, Puchades Gimeno F, Benlloch Pérez S, Sanz Herrero F, Latorre Sánchez M, et all. Abnormal liver chemistry constitutes an independent prognostic factor of less favorable clinical course in patients with COVID-19. 7842/2021


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Publication history

Received: 30/01/2021

Accepted: 03/06/2021

Online First: 23/06/2021

Published: 09/12/2021

Article revision time: 121 days

Article Online First time: 144 days

Article editing time: 313 days


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