COVID-19 and liver disease: Are we missing something?

Area of Science:

• Hepatology
• Infectious Diseases
• Biochemistry

Background:

• The COVID-19 pandemic prompted extensive research into diagnostics and prognostic factors.
• Elevated liver enzymes have been noted in COVID-19 patients, but their interpretation is complex.

Purpose of the Study:

• To investigate the association between liver enzymes, specifically AST, and outcomes in COVID-19 patients.
• To evaluate the utility of the AST/ALT ratio as a prognostic marker in COVID-19.

Main Methods:

• Analysis of liver enzyme levels, including AST and ALT, in COVID-19 patients.
• Comparison of enzyme levels between survivors and non-survivors.
• Assessment of the AST/ALT ratio in relation to patient outcomes.

Main Results:

• Non-survivors of COVID-19 exhibited significantly higher aspartate aminotransferase (AST) levels.
• An elevated AST/alanine aminotransferase (ALT) ratio was also observed in non-survivors.
• The non-specific nature of AST, found in multiple organs, complicates direct interpretation of liver injury.

Conclusions:

• Elevated AST and AST/ALT ratio may indicate poor prognosis in COVID-19 patients.
• Caution is advised when interpreting elevated AST levels due to its extrahepatic presence.
• Pre-existing conditions like metabolic syndrome and NAFLD can confound liver function tests in COVID-19 patients.