Liver dysfunction on admission worsens clinical manifestations and outcomes of coronavirus disease 2019

Fangying Lu; Rong Chen; Kandi Xu; Jie Huang; Dexiang Yang; Tao Bai; Yusang Xie; Yun Ling; Kui Liu; Wei Du; Jiayang Yan; Huihuang Lin; Jian Li; Yun Feng; Min Zhou; Yi Guo

doi:10.1016/j.pccm.2023.08.004

Liver dysfunction on admission worsens clinical manifestations and outcomes of coronavirus disease 2019

Chin Med J Pulm Crit Care Med. 2023 Sep 14;1(3):181-187. doi: 10.1016/j.pccm.2023.08.004. eCollection 2023 Sep.

Authors

Fangying Lu^{1

2}, Rong Chen^{1

2}, Kandi Xu^{1

2}, Jie Huang³, Dexiang Yang⁴, Tao Bai⁵, Yusang Xie^{1

2}, Yun Ling⁶, Kui Liu⁷, Wei Du^{1

2}, Jiayang Yan^{1

2}, Huihuang Lin^{1

2}, Jian Li⁸, Yun Feng^{1

2}, Min Zhou^{1

2}, Yi Guo^{1

2}

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
² Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
³ Department of Critical Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
⁴ Department of Respiratory Diseases, Tongling People's Hospital, Tongling, Anhui 244099, China.
⁵ Department of Infectious Disease, Wuhan Jinyintan Hospital, Wuhan, Hubei 430048, China.
⁶ Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 200025, China.
⁷ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
⁸ Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.

Abstract

Background: Liver dysfunction was common in coronavirus disease 2019 (COVID-19), but its association with clinical features and poor prognosis has not been fully delineated. Our study aimed to determine the role of liver dysfunction in COVID-19 and understand the predictors for worse outcomes in patients with liver injury.

Methods: We conducted this multicenter, retrospective study in five designated hospitals for COVID-19 management. Laboratory-confirmed COVID-19 patients were enrolled and classified into the normal live function group and liver dysfunction group according to liver enzymes, bilirubin, and albumin on admission, respectively. Data of baseline, clinical manifestations, and outcomes were collected and compared in the paired groups.

Results: Of the 649 included COVID-19 patients, 200 (30.8%), 69 (10.6%), and 267 (41.1%) patients had elevated liver enzymes, increased bilirubin, and low-level albumin, respectively. Fever, cough, and dyspnea were the most common symptoms and showed an increased proportion in the liver dysfunction group. Compared with patients in the normal liver function group, patients with liver dysfunction manifested decreased lymphocytes, higher level of leukocytes, neutrophils, inflammatory indicators, and cytokines, as well as more severe impairment in kidney function and myocardium. They were more likely to show bilateral involvement and more pulmonary lobes involved according to chest images. With increased proportion of patients who developed severe/critical conditions and needed mechanical ventilation and systemic glucocorticoid therapy, patients with liver dysfunction on admission showed significantly higher in-hospital mortality. Moreover, cardiac troponin I ≥1.5 ng/mL was identified as an independent mortality predictor in the elevated liver enzymes group.

Conclusion: Patients with liver dysfunction on admission had worse clinical manifestation, and resulted in higher rate of severe/critical type, receiving mechanical ventilation and in-hospital mortality.

Keywords: COVID-19; Clinical manifestation; Liver dysfunction; Mortality; Outcomes.