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


During the study period, 300 patients were admitted in COVID-19 units of the two referral hospitals. In all, 234 patients were included in the final analysis after being confirmed positive for SARS-CoV-2 by RT-PCR in nasopharyngeal samples (Figure S1). In total, 149 patients (63.7%) were men, and the mean (SD) age was 67 (14) years (Table 1). In all, 156 (66.6%) patients had abnormal liver function tests on admission, and 22 (9.4%) patients presented with ALT > 2-fold ULN or TBil > ULN. In all, 175 (74.8%) patients had at least one comorbidity. In total, 108 (46.2%) patients had arterial hypertension and 68 (29%) were treated with either angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Current treatment with ACEIs or ARBs did not impact disease severity or clinical outcomes (Table S1). In a univariate analysis, patients with abnormal liver tests on admission were more likely to need ICU admission, intubation and mechanical ventilation. Also, abnormal liver tests on admission were associated with severe disease upon admission and in-hospital mortality (Table 1). The survival probability 25 days after hospital admission was significantly worse in patients with abnormal liver tests on admission compared to patients with normal liver tests (Figure 1). In a multivariate logistic regression analysis, abnormal liver tests on admission were strongly associated with in-hospital aggravation (OR = 4.1, 95% CI 1.5–10.8; P = .004) together with older age (OR 1.037, 95% CI 1.007–1.067, P = .007) and higher CRP (OR 1.037, 95% CI 1.003–1.011, P = .001) but not comorbidities (P > .05) (Table S2). Also abnormal liver function tests on admission were independently associated with in-hospital mortality (OR 3.3; 95% CI = 1.04–10.5; P = .04) together with older age (OR 1.14; 95% CI 1.08–1.21; P = .001) and higher CRP (OR 1.007, 95% CI 1.002–1.013; P = .009) (Table S3).

Figure 1.

Kaplan-Meier survival curves comparing COVID-2 patients with normal and abnormal liver function tests on admission

During hospitalization, specific COVID-19 drug treatment was prescribed in 125 (53.4%) patients: 86 (36.7%) received hydroxychloroquine, 27 (11.5%) lopinavir/ritonavir and 12 (5.1%) remdesivir respectively. Of the 30 patients discharged and who had normal liver tests on admission, 16 (53.4%) had abnormal liver tests at discharge; 8 (50%) had received hydroxychloroquine and 14 (87.5%) had received antibiotics such as azithromycin, amoxicillin-clavulanic acid or quinolones. By the end of the study period, 186 (79.5%) patients were discharged, and 48 (20.5%) remained hospitalized.