Abnormal Liver Tests in Patients Hospitalized With Coronavirus Disease 2019: Should We Worry?

Magdalena Meszaros; Lucy Meunier; David Morquin; Kada Klouche; Pierre Fesler; Emilie Malezieux; Alain Makinson; Vincent Le Moing; Jacques Reynes; Georges-Philippe Pageaux


Liver International. 2020;40(8):1860-1864. 

In This Article


We retrospectively studied a cohort of COVID-19 patients hospitalized in two COVID-19 referral hospitals in France (CHU Montpellier and CH Narbonne). All consecutive patients admitted to both hospitals from 10 March to 18 April 2020 with confirmed SARS-CoV-2 infection, according to WHO guidelines[8] by positive result of reverse transcription polymerase chain reaction (RT-PCR) in nasopharyngeal samples, were included. Clinical, biological and chest computed tomography (CT) data were collected. On admission, every patient was screened for comorbidities, antihypertensive therapy, immunosuppression status, underlying liver disease, elapsed time from symptoms onset to hospitalization, laboratory findings including platelets, C-reactive protein, liver function tests, serum albumin, procalcitonin, D-dimer and lymphocyte count. During hospitalization, data on need for mechanical intubation, initial hospitalization service, need for intensive care unit hospitalization, length of hospital stay, COVID-specific drug treatment were collected. Clinical outcomes included type of first admission unit, invasive mechanical ventilation and status deceased or alive.

Abnormal liver function was defined as any parameter over the upper limit of normal (ULN): alanine transaminase (ALT) >41 U/L, aspartate transaminase (AST) >40 U/L, alkaline phosphatase (ALP) >130 U/L, gamma-glutamyl transferase (GGT) >60 U/L and total bilirubin (TBil) >21 μmol/L. All patients were classified into severe or non-severe COVID-19 pneumonia at the time of admission according to current guidelines.[8] Severe cases were defined by fever or suspected respiratory infection, plus one of the following: respiratory rate >30 breaths/min; severe respiratory distress; or SpO2 < 93% on room air. In-hospital aggravation was defined by any of the following characteristics established in hospital but not present on admission: (a) oxygen saturation at rest <93%; (b) need for mechanical ventilation; (c) acute respiratory distress syndrome (PaO2/FiO2 < 300, >30 breaths/min) and (d) any organ failure or shock requiring intensive care management.

The ethics committee of the University Hospital of Montpellier granted ethical approval and patients gave informed consent.

Statistical analyses were performed using XLSTAT 2019.3.2. Continuous variables were expressed as mean and standard deviation (SD). Differences in non-Gaussian distributions were assessed with Mann-Whitney U test and normal distributions with Student's t test. Categorical variables were expressed as percentages and analysed using chi-square test. Survival data were analysed with Kaplan-Meier plots and log-rank tests, taking time-to-event data into account. Multivariate logistic regression was performed to identify risk factors associated with in-hospital aggravation and death. Variables included in the model were as follows: abnormal liver test, CRP, comorbidities and age after their validation in univariate analysis. Before entering these variables, multicollinearity was excluded. The contribution of each variable to the risk of developing the endpoint is reported as odds ratio (OR) with 95% confidence interval (CI). A P value <.05 was considered significant.