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Gamma-Glutamyltransferase Elevation Is Frequent in Patients With COVID-19: A Clinical Epidemiologic Study
Tuo Shao1, Yu Tong2, Shushu Lu3
1Liver Center and Gastrointestinal Division Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MA.
Insights
Elevated gamma-glutamyltransferase (GGT) levels were found in 32.7% of patients with coronavirus disease 2019 (COVID-19). This finding suggests potential liver involvement in COVID-19 patients, indicating the need for further research.
Area of Science:
- Hepatology
- Infectious Diseases
- Biochemistry
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a global health threat.
- Previous studies noted variable liver enzyme levels (ALT, AST) in COVID-19 patients.
- Gamma-glutamyltransferase (GGT), a cholangiocyte injury biomarker, has not been reported in COVID-19 studies.
Purpose of the Study:
- To investigate the relationship between GGT levels and clinical/biochemical characteristics in COVID-19 patients.
- To assess the prevalence of elevated GGT in hospitalized COVID-19 patients.
- To determine if GGT elevation correlates with disease severity or patient demographics.
Main Methods:
- Retrospective case series of 98 hospitalized COVID-19 patients.
- Data collected via standardized case report forms and medical record analysis.
- COVID-19 diagnosis confirmed by symptomatology, RT-PCR, and CT scans.
Main Results:
- Elevated GGT levels observed in 32.7% of patients.
- Higher GGT associated with older age (>40), male sex, elevated CRP, ALT, ALP, and triglycerides in patients without chronic liver disease.
- Elevated GGT and CRP correlated with longer hospital stays.
Conclusions:
- A significant proportion of COVID-19 patients exhibit elevated serum GGT levels.
- This elevation suggests potential liver injury or involvement in COVID-19.
- GGT may serve as a useful biomarker in assessing COVID-19 patients.
Abstract:
A newly identified coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the infectious coronavirus disease 2019 (COVID-19), emerged in December 2019 in Wuhan, Hubei Province, China, and now poses a major threat to global public health. Previous studies have observed highly variable alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in patients with COVID-19. However, circulating levels of the cholangiocyte injury biomarker gamma-glutamyltransferase (GGT) have yet to be reported in the existing COVID-19 case studies. Herein, we describe the relationship between GGT levels and clinical and biochemical characteristics of patients with COVID-19. Our study is a retrospective case series of 98 consecutive hospitalized patients with confirmed COVID-19 at Wenzhou Central Hospital in Wenzhou, China, from January 17 to February 5, 2020. Clinical data were collected using a standardized case report form. Diagnosis of COVID-19 was assessed by symptomatology, reverse-transcription polymerase chain reaction (RT-PCR), and computed tomography scan. The medical records of patients were analyzed by the research team. Of the 98 patients evaluated, elevated GGT levels were observed in 32.7%; increased C-reactive protein (CRP) and elevated ALT and AST levels were observed in 22.5%, 13.3%, and 20.4%, respectively; and elevated alkaline phosphatase (ALP) and triglycerides (TGs) were found in 2% and 21.4%, respectively. Initially, in the 82 patients without chronic liver disease and alcohol history, age older than 40 years (P = 0.027); male sex (P = 0.0145); elevated CRP (P = 0.0366), ALT (P < 0.0001), and ALP (P = 0.0003); and increased TGs (P = 0.0002) were found to be associated with elevated GGT levels. Elevated GGT (P = 0.0086) and CRP (P = 0.0162) levels had a longer length of hospital stay. Conclusion: A sizable number of patients with COVID-19 infection have elevated serum GGT levels. This elevation supports involvement of the liver in persons with COVID-19.
