Effect of liver injury on prognosis and treatment of hospitalized patients with COVID-19 pneumonia

Guo-Guang Ma; Ya-Xing Shen; Ling Wu; Zhe Luo; Chou-Wen Zhu; Shi-Yao Chen; Kai-Huan Yu; Feng Li

doi:10.21037/atm-20-4850

Effect of liver injury on prognosis and treatment of hospitalized patients with COVID-19 pneumonia

Ann Transl Med. 2021 Jan;9(1):10. doi: 10.21037/atm-20-4850.

Authors

Guo-Guang Ma¹, Ya-Xing Shen², Ling Wu³, Zhe Luo^{1

4}, Chou-Wen Zhu^{3

5}, Shi-Yao Chen^{3

5

6}, Kai-Huan Yu⁷, Feng Li^{3

6}

Affiliations

¹ Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
⁵ Evidence-based Medicine Center, Fudan University, Shanghai, China.
⁶ Department of Gastroenterology, Minhang Hospital, Fudan University, Shanghai, China.
⁷ Department of Hepatobiliary Surgery, People's Hospital of Wuhan University, Wuhan, China.

Abstract

Background: Liver injury is common in patients with coronavirus disease 2019 (COVID-19), although its effect on patient outcomes has not been well studied. This study aimed to evaluate the effect of liver injury on the prognosis and treatment of patients with COVID-19 pneumonia.

Methods: In this retrospective, single-center study, data on 109 hospitalized patients with COVID-19 pneumonia were extracted and analyzed. The primary composite end-point event was the use of mechanical ventilation or death.

Results: At admission, of the 109 patients enrolled, 56 patients (51.4%) were diagnosed with severe disease, and 39 (35.8%) presented with liver injury, which mainly manifested as elevated levels of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) accompanied simultaneously by an increase in the level of γ-glutamyl transferase. A primary composite end-point event occurred in 21 patients (19.3%). Liver injury was more prevalent in patients with severe disease than in those with non-severe disease (46.4% vs. 24.5%, P=0.017). However, there was no significant difference found between severe and non-severe patients in the use of mechanical ventilation, mortality, hospital stay, or use and dosage of glucocorticoids between individuals with and without liver injury (all P>0.05). The degree of disease severity (OR =7.833, 95% CI, 1.834-31.212, P=0.005) and presence of any coexisting illness (OR =4.736, 95% CI, 1.305-17.186, P=0.018) were predictable risk factors for primary composite end-point events, whereas liver injury had no significance in this aspect (OR =0.549, 95% CI, 0.477-5.156, P=0.459).

Conclusions: Liver injury was more common in severe cases of COVID-19 pneumonia than in non-severe cases. However, liver injury had no negative effect on the prognosis and treatment of COVID-19 pneumonia.

Keywords: Coronavirus disease 2019 (COVID-19); clinical prognosis; liver injury; pneumonia; treatment.