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Liver Injury in Patients Hospitalized with Coronavirus Disease 2019 Correlates with Hyperinflammatory Response and

Ben L Da1,2, Tatyana Kushner1, Maan El Halabi3

  • 1Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA.

Hepatology Communications
|November 24, 2020
PubMed

Insights

Severe COVID-19 patients with liver injury showed higher levels of inflammation markers, including C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and interleukin-6 (IL-6). This suggests a link between cytokine storm and liver damage in critical coronavirus disease 2019.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Immunology

Background:

  • Liver injury is a frequent complication of coronavirus disease 2019 (COVID-19).
  • The mechanisms and clinical course of liver injury in severe and critical COVID-19 remain poorly understood.

Purpose of the Study:

  • To investigate the association between liver injury and immunologic markers in severe and critical COVID-19 patients.
  • To describe the clinical characteristics of COVID-19 patients with liver injury.

Main Methods:

  • Retrospective cohort study of 176 hospitalized patients with severe/critical COVID-19.
  • Patients were categorized into groups with and without liver injury (defined by elevated aminotransferases).
  • Immunologic testing included interleukin-6 (IL-6), IL-8, tumor necrosis factor alpha (TNF-α), and IL-1β.

Main Results:

  • The liver injury group (109 patients) had significantly higher levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and IL-6 compared to controls (67 patients).
  • Patients with liver injury were more likely to be male and experienced longer hospital stays and more severe COVID-19.
  • No significant differences were observed in IL-8, TNF-α, and IL-1β levels between groups.

Conclusions:

  • An exaggerated hyperinflammatory response, or cytokine storm, characterized by elevated CRP, LDH, ferritin, and IL-6, is associated with liver injury in severe/critical COVID-19.
  • These findings highlight the role of systemic inflammation in the pathogenesis of COVID-19-related liver injury.

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