Longitudinal Association Between Markers of Liver Injury and Mortality in COVID‐19 in China

• DOI: 10.1002/hep.31301
• Publication Date: 2020-05-02T20:04:26Z
• Authors: Fang Lei; Ye‐Mao Liu; Feng Zhou; Juan‐Juan Qin; Peng Zhang; Lihua Zhu; Xiao‐Jing Zhang; Jingjing Cai; Lijin Lin; Shan Ouyang; Xiaoming Wang; Chengzhang Yang; Xu Cheng; Weifang Liu; Haomiao Li; Jing Xie; Bin Wu; Huiming Luo; Fei Xiao; Jing Chen; Liang Tao; Gang Cheng; Zhi‐Gang She; Jianghua Zhou; Haitao Wang; Jun Lin; Pengcheng Luo; Shouzhi Fu; Jihui Zhou; Ping Ye; Bing Xiao; Weiming Mao; Liming Liu; Youqin Yan; Ling Liu; Guohua Chen; Hongliang Li; Xiaodong Huang; Bing‐Hong Zhang; Yufeng Yuan
• Keywords: Adult; Male; 0303 health sciences; Hepatology; SARS-CoV-2; Pneumonia, Viral; COVID-19; Alanine Transaminase; Bilirubin; Middle Aged; Alkaline Phosphatase; 3. Good health; Betacoronavirus; 03 medical and health sciences; Liver; Humans; Female; Aspartate Aminotransferases; Longitudinal Studies; Coronavirus Infections; Pandemics; Biomarkers; Aged; Retrospective Studies

Background and Aims Coronavirus disease 2019 (COVID‐19) is a new infectious disease. To reveal the hepatic injury related to this disease and its clinical significance, we conducted a multicenter retrospective cohort study that included 5,771 adult patients with COVID‐19 pneumonia in Hubei Province.

Approach and Results We reported the distributional and temporal patterns of liver injury indicators in these patients and determined their associated factors and death risk. Longitudinal liver function tests were retrospectively analyzed and correlated with the risk factors and death. Liver injury dynamic patterns differed in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBIL). AST elevated first, followed by ALT, in severe patients. ALP modestly increased during hospitalization and largely remained in the normal range. The fluctuation in TBIL levels was mild in the non‐severe and the severe groups. AST abnormality was associated with the highest mortality risk compared with the other indicators of liver injury during hospitalization. Common factors associated with elevated liver injury indicators were lymphocyte count decrease, neutrophil count increase, and male gender.

Conclusion The dynamic patterns of liver injury indicators and their potential risk factors may provide an important explanation for the COVID‐19‐associated liver injury. Because elevated liver injury indicators, particularly AST, are strongly associated with the mortality risk, our study indicates that these parameters should be monitored during hospitalization.