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Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential

Donovan A McGrowder1, Fabian Miller2,3, Melisa Anderson Cross4

  • 1Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica.

Diseases (Basel, Switzerland)
|July 21, 2021
PubMed

Insights

The coronavirus disease 2019 (COVID-19) can cause liver injury through various mechanisms, impacting patients with chronic liver conditions. Monitoring liver biochemistry tests is crucial for assessing COVID-19 severity and patient outcomes.

Area of Science:

  • Hepatology
  • Virology
  • Internal Medicine

Background:

  • The coronavirus disease 2019 (COVID-19) pandemic has led to significant global mortality and impacted healthcare systems, including the management of patients with chronic liver diseases.
  • COVID-19 poses a risk to individuals with pre-existing liver conditions such as chronic active hepatitis, cirrhosis, and hepatocellular carcinoma.
  • Potential mechanisms for liver injury in COVID-19 patients include drug-induced hepatotoxicity, direct SARS-CoV-2 infection of liver cells, hypoxia, and systemic inflammation.

Purpose of the Study:

  • To systematically review abnormal liver biochemistry tests in COVID-19 patients.
  • To explore the potential pathogenic mechanisms underlying liver injury in COVID-19.
  • To highlight findings related to disease severity, patterns of liver injury, incidence, and clinical outcomes.

Main Methods:

  • Systematic review of literature concerning abnormal liver biochemistry tests in COVID-19.
  • Analysis of reported liver function test abnormalities, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP).
  • Correlation of liver biochemistry derangements with disease severity and clinical outcomes.

Main Results:

  • Liver biochemistry tests are frequently deranged in COVID-19 patients, serving as prognostic markers for disease severity.
  • Hepatocellular damage is indicated by elevated AST and ALT levels in early disease stages.
  • A cholestatic pattern, characterized by increased ALP, GGT, and bilirubin levels, may develop as COVID-19 progresses.

Conclusions:

  • Abnormal liver biochemistry tests are common in COVID-19 and reflect underlying liver injury.
  • These tests provide valuable prognostic information regarding disease severity and clinical outcomes.
  • Careful monitoring of liver function is recommended for COVID-19 patients, particularly those with pre-existing liver conditions.

Keywords:
acutebiochemistrycoronavirusdiseasefunctioninfectioninjurylivermortalityseveritytests

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