Liver Complications Common With COVID-19

By Will Boggs MD

July 02, 2020

NEW YORK (Reuters Health) - Liver complications are common and are associated with more severe disease in patients with COVID-19, according to a new review.

"The data confirms that COVID-19 has extrapulmonary manifestations - systemic effects," Dr. Setor K. Kunutsor of Bristol Medical School and University Hospitals Bristol NHS Foundation Trust, University of Bristol, in the UK, told Reuters Health by email. "Apart from the respiratory, cardiovascular, and renal systems, the virus also affects the digestive system, including the liver."

Several studies have reported increased liver enzyme abnormalities in patients with COVID-19, and some reports include chronic liver disease as a risk factor for severe illness or death with COVID-19.

Dr. Kunutsor and Dr. Jari A. Laukkanen of the University of Eastern Finland, in Kuopio, evaluated the hepatic manifestations and complications of COVID-19 in a systematic review of 19 retrospective cohort studies (14 from China and five from the USA), including more than 15,000 patients with COVID-19.

Pre-existing chronic liver disease appeared to be present in only 1.9% of patients, including cirrhosis (0.4%), hepatitis B (0.9%), and hepatitis C (0.3%), the researchers report in the Journal of Infection.

On admission, 26.6% of patients had elevated alanine aminotransferase (ALT), 37.2% had elevated aspartate aminotransferase (AST), 45.6% had low albumin and 18.2% had elevated total bilirubin.

During the course of hospital stays ranging from two to 28 days, 69.1% of patients had elevated ALT, 34.8% had elevated AST, 11.2% had acute hepatic injury, and 7.9% had hypoproteinemia.

The incidence of acute hepatic injury was higher in Chinese populations and in populations with a higher prevalence of pre-existing chronic liver disease, but it was similar in patients older and younger than 60 years.

Patients with pre-existing liver dysfunction and those with acute hepatic injury associated with COVID-19 appeared to have an increased risk of severe COVID-19 and fatal outcomes.

"Intensive public health education is needed for these at-risk groups, so they can stringently adopt all the public-health measures put in place to prevent or slow down the transmission of the virus," Dr. Kunutsor said.

"Markers of liver dysfunction, such as the aminotransferases, should be assessed once patients are admitted and these should be monitored closely, to enable more aggressive intervention," he said.

"Furthermore, some of the drugs administered during treatment could also be the cause of liver injury, so care is needed when administering these drugs, especially for those with pre-existing liver disease," Dr. Kunutsor said.

SOURCE: Journal of Infection, online June 20, 2020.