Clinical Course and Risk Factors for Liver Injury of Severe and Critical Patients with COVID-19

Chunjing Du,1,&ast; Siyuan Yang,2,&ast; Chuansheng Li,1 Pan Xiang,1 Lin Pu,1 Jingyuan Liu1 1Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Laboratory of Infectious Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jingyuan Liu; Lin Pu, Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Chaoyang District, Beijing, 100015, People’s Republic of China, Tel +86 108432682; +86 108432966, Email dtyyicu@ccmu.edu.cn; pulin1103@ccmu.edu.cnIntroduction: Information regarding the clinical course of COVID-19 patients with liver injury is very limited, especially in severe and critical patients. The objective of this study was to describe the characteristics and clinical course of liver function in patients admitted with severe and/or critical SARS-CoV-2 infection, as well as explore the risk factors that affect liver function in the enrolled COVID-19 patients.Methods: Information on clinical characteristics of 63 severe and critical patients with confirmed COVID-19 was collected. Data on patients’ demographics, laboratory characteristics, laboratory examination, SARS-CoV-2 RNA results and liver test parameters were acquired and analyzed.Results: The incidence of abnormal aspartate aminotransferase, alanine aminotransferase, and total bilirubin in the critical group was significantly higher than in the severe group (respectively 81.48%, 81.49%, 62.67%, and 45.71%, 63.88%, 22.86%, p < 0.05). The time for liver function parameters to reach their extremes was approximately 2– 3 weeks after admission. The independent factors associated with liver injury were patients with invasive ventilators, decreased percentages of neutrophils, lymphocytes and monocytes, and sequential organ failure assessment (SOFA) score ≥ 2 (p < 0.05).Conclusion: Abnormal liver tests are commonly observed in severe and critical patients with COVID-19. Severe patients infected by SARS-CoV-2 should be closely observed and monitored the liver function parameters, particularly when they present with independent risk factors for liver injury.Keywords: abnormal liver tests, coronavirus disease 2019, COVID-19, liver injury, pneumonia, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2