Clinical Characteristics of Non-ICU Hospitalized Patients With Coronavirus Disease 2019 and Liver Injury

A Retrospective Study

Hansheng Xie; Jianming Zhao; Ningfang Lian; Su Lin; Qunfang Xie; Huichang Zhuo


Liver International. 2020;40(6):1321-1326. 

In This Article


A total of 79 cases with confirmed COVID-19 were included in this study. The median age was 60.0 years (range 27–87 years), and 44 (55.7%) were male. 34.5% patients met the diagnostic criteria of severe COVID-19. No patient needed invasive mechanical ventilation. The median durations from initial symptoms to admission were 12 days. Common symptoms included cough (70.9%), fever (70.9%) and dyspnoea (50.6%). Of all the patients, 21 (26.5%) had 1 or more coexisting chronic medical conditions. There was no significant difference in gender, age, symptoms and underlying disease between the severe group and the general group (P > .05; Table 2). The levels of average CRP, D-dimer, Fibrinogen and erythrocyte sedimentation rate (ESR) elevated. The levels of average of Lymphocyte counts decreased. The median time from the admission to first negative result of pharyngeal swab was 5.1 days. The average length of hospital stay was about 11.9 days.

31.6% patients had elevated ALT, 35.4% patients had elevated AST and 5.1% had elevated bilirubin. The patients were divided into two groups based on the presence or absence of liver injury. The clinical characteristics of the two groups were compared. The ratio of male was higher in patients with liver damage than in patients without liver injury (P < .05). There were increased levels of white blood cell counts, neutrophils and CRP in the liver injury group (P < .05). The CT score of the liver injury group was significantly higher than that of the non-liver injury group (P < .05). The incidences of liver injury were 13.3%, 36.4% and 77.8% in the patients with CT scores of <5, 5–15 and >15 points respectively (χ 2 = 10.06, P = .007). All patients got improvement in clinical symptoms, negative coronavirus test and were discharged in this study, while patients with liver damage had longer length of stay than patients without liver injury (P < .05). The liver enzymes after treatment between patients with and without liver injury were not significantly different (Table 3).

Table 4 shows the correlations among baseline ALT, AST and the other variables. Both indices were significantly correlated with the ratio of male, CRP and D-dimer (all P < .05). CT scores, as an expression of the severity of COVID-19, was also correlated with ALT and AST (r = .524, P = .000 and r = .550, P = .000 respectively). And the level of white blood cell counts and neutrophils were correlated with ALT (both P < .05). Finally, stepwise logistic regression suggested that CT scores were an independent predictor for liver injury after adjusting for male, CRP and D-dimer (odds ratio [OR] = 5.265, 95% CI (1.025–1.371), P = .022).