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Risk Factors for Liver Injury and Their Association with Treatment in Hospitalized Patients with COVID-19
Chihiro Kato1, Yutaka Ito1, Yuta Mori1
1Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences and Medical School, Japan.
Internal Medicine (Tokyo, Japan)
|March 16, 2025
Summary
This study found that male sex, severe COVID-19, and higher admission alanine aminotransferase (ALT) levels increase the risk of acute liver injury (ALI) in hospitalized patients. Tocilizumab may be associated with ALI, but remdesivir was not.
Area of Science:
- Hepatology
- Infectious Diseases
- Internal Medicine
Background:
- Coronavirus disease 2019 (COVID-19) can lead to various complications, including liver injury.
- Understanding the incidence and risk factors for acute liver injury (ALI) in COVID-19 patients is crucial for effective management.
- The role of specific treatments in the development of ALI requires further investigation.
Purpose of the Study:
- To determine the frequency and risk factors associated with acute liver injury (ALI) in hospitalized COVID-19 patients.
- To examine the relationship between ALI and treatments such as remdesivir and tocilizumab.
Main Methods:
- A single-center retrospective study included 631 adult patients hospitalized with COVID-19 between July 2020 and January 2024.
- Data on demographics, clinical characteristics, and laboratory values were extracted from electronic medical records.
- ALI was diagnosed based on established Asia Pacific Association of the Study of Liver guidelines; risk factors were assessed using logistic regression and propensity score matching.
Main Results:
- 12.0% of patients (76/631) developed ALI.
- Risk factors for ALI included male sex (OR=3.052), higher WHO ordinal scale score (OR=1.408), elevated ALT at admission (OR=1.017), and tocilizumab administration (OR=2.788). Absence of diabetes and dyslipidemia were protective.
- Propensity score matching indicated no association between remdesivir or tocilizumab and ALI.
Conclusions:
- Male gender, severe COVID-19 illness, and elevated admission ALT levels are significant risk factors for ALI in COVID-19 patients.
- While initial analysis suggested an association between tocilizumab and ALI, propensity score matching did not confirm this link.
- Remdesivir treatment was not found to be associated with an increased risk of ALI.
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