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Liver Biochemistries in Hospitalized Patients With COVID-19
Patricia P Bloom1,2, Eric A Meyerowitz2,3, Zoe Reinus1
1Division of GastroenterologyDepartment of MedicineMassachusetts General HospitalBostonMA.
Insights
Elevated liver enzymes, particularly aspartate aminotransferase (AST), are common in COVID-19 patients and correlate with disease severity. This suggests genuine liver injury during the illness.
Area of Science:
- Hepatology
- Infectious Diseases
- Internal Medicine
Background:
- Coronavirus disease 2019 (COVID-19) frequently presents with elevated liver biochemistries in about half of patients.
- Limited data exist on the longitudinal trends of liver biochemistries during the course of COVID-19 illness.
Purpose of the Study:
- To evaluate the trend, etiology, and outcomes associated with liver biochemistries in patients with COVID-19.
- To investigate the correlation between liver enzyme elevations and disease severity.
Main Methods:
- Retrospective analysis of 60 COVID-19 patients admitted between March 21-28, 2020.
- Monitoring of liver biochemistries (AST, ALT, alkaline phosphatase, total bilirubin) during hospitalization.
- Correlation analysis with demographic data, comorbidities, and clinical outcomes (e.g., intubation status).
Main Results:
- 69% of patients had abnormal liver biochemistries on admission; 93% developed elevated aminotransferases during hospitalization.
- Aspartate aminotransferase (AST) elevations were more common and higher than alanine aminotransferase (ALT) elevations.
- Higher AST and ALT levels were observed in intubated patients, indicating a correlation with disease severity.
- Elevations in alkaline phosphatase and total bilirubin were infrequent.
Conclusions:
- AST-dominant aminotransferase elevation is a frequent finding in COVID-19.
- These liver enzyme elevations appear to reflect true hepatic injury and correlate with COVID-19 disease severity.
- Liver biochemistries, particularly AST, can serve as a marker for disease severity in COVID-19.
Background And Aims:
Coronavirus disease 2019 (COVID-19) leads to elevated liver biochemistries in approximately half of patients on presentation. To date, data are limited regarding the trend of liver biochemistries over the course of illness. We aimed to evaluate the trend, etiology, and outcomes associated with liver biochemistries in COVID-19.
Approach And Results:
A total of 60 patients with COVID-19 were admitted between March 21 and March 28, 2020. The mean age was 57 years, 65% were male, and 28% were Hispanic. At the study conclusion, 6 patients were deceased, 28 were discharged, and 26 remained admitted. Patients who remained admitted were followed for a median of 12 days. Of 60 patients, 41 (69%) had at least one abnormal liver biochemistry on admission. Median aspartate aminotransferase (AST) was higher than alanine aminotransferase (ALT) at admission (46 vs. 30 U/L) and during the hospital course. Aminotransferases rose above normal in 54 (93%) patients, whereas alkaline phosphatase and total bilirubin elevations were rare. Ten (17%) patients developed aminotransferases more than 5 times the upper limit of normal. AST highly correlated with ALT throughout the illness course (r = 0.97; P < 0.0001), whereas correlations with markers of muscle injury and inflammation were weak. Statin use was common before (40%) and during admission (80%) at our center, with no difference in peak liver biochemistries between users and nonusers. No demographic or comorbid illness was associated with liver injury. Admission AST (69 vs. 49; P < 0.05), peak AST (364 vs. 77; P = 0.003), and peak ALT (220 vs. 52; P = 0.002) were higher in intubated patients.
Conclusions:
AST-dominant aminotransferase elevation is common in COVID-19, mirrors disease severity, and appears to reflect true hepatic injury.
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