Clinical Features of COVID-19 Related Liver Damage

BACKGROUND: A recent outbreak of SARS-CoV-2 infection occurs mainly in China, with rapidly increasing the number of cases (namely COVID-19). Abnormal liver functions are frequently present in these patients, here we aimed to clarify the clinical features of COVID-19-related liver damage to provide some references for the clinical treatment. METHODS: In this retrospective, single-center study, we included all confirmed COVID-19 cases in Shanghai Public Health Clinical Center from January 20 to January 31, 2020. The outcomes were followed up until February 19, 2020. A total of 148 cases were analyzed for clinical features, laboratory parameters (including liver function tests), medications and the length of stay. FINDINGS: Of 148 confirmed SARS-CoV-2-infected patients, 49.3% were females and 50.7% were males. The median age was 50.5 years (interquartile range, 36-64). Patients had clinical manifestations of fever (70.1%), cough (45.3%), expectoration (26.7%) at admission. 75 patients (50.7%) showed abnormal liver functions at admission, characterized by an increased of alt, ast, GGT, AKP. Patients (n = 75) who had elevated liver function index were more likely to have a moderate-high degree fever (44% vs 27.4%; p = 0.035) and significantly present in male patients (62.67% vs 38.36%; p = 0.005). The numbers of CD4+ and CD8+ T cells were significantly lower in abnormal liver function group than those in normal liver function group. There was no statistical difference in prehospital medications between normal and abnormal liver function groups, while the utilization rate of lopinavir/ritonavir after admission was significantly higher in patients with emerging liver injury than that in patients with normal liver functions. Importantly, the emerging abnormal liver functions after admission caused a prolonged length of stay. INTERPRETATION: SARS-CoV-2 may cause the liver function damage and the Lopinavir/ritonavir should be applied carefully for the treatment of COVID-19.

[1]  Jue Fan,et al.  Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection , 2020, bioRxiv.

[2]  Kai Zhao,et al.  A pneumonia outbreak associated with a new coronavirus of probable bat origin , 2020, Nature.

[3]  F. Pei,et al.  Severe Acute Respiratory Syndrome Associated Coronavirus Is Detected in Intestinal Tissues of Fatal Cases , 2005, The American Journal of Gastroenterology.

[4]  Christian Drosten,et al.  Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group , 2020, bioRxiv.

[5]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[6]  Qun Li.  Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia , 2020 .

[7]  S. Lindstrom,et al.  First Case of 2019 Novel Coronavirus in the United States , 2020, The New England journal of medicine.

[8]  R. Tzonev,et al.  A case of late presentation of darunavir-related cholestatic hepatitis , 2019, International journal of STD & AIDS.

[9]  Novel Coronavirus Pneumonia Emergency Response Epidemiol Team.  [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. , 2020, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[10]  Wei Liu,et al.  Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China , 2020, medRxiv.

[11]  Jing Zhao,et al.  Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia , 2020, The New England journal of medicine.

[12]  G. Gao,et al.  A Novel Coronavirus from Patients with Pneumonia in China, 2019 , 2020, The New England journal of medicine.

[13]  J. Kraft,et al.  Diagnostic value for acute myocardial infarction of creatine kinase and lactate dehydrogenase isoenzymes compared with total enzymes. Creatine kinase isoenzyme specificity for myocardial damage. , 2009, Acta medica Scandinavica.

[14]  Jiyuan Zhang,et al.  Pathological findings of COVID-19 associated with acute respiratory distress syndrome , 2020, The Lancet Respiratory Medicine.

[15]  Peter Cameron,et al.  A major outbreak of severe acute respiratory syndrome in Hong Kong. , 2003, The New England journal of medicine.

[16]  Mitchell R. McGill,et al.  Oxidant stress, mitochondria, and cell death mechanisms in drug-induced liver injury: Lessons learned from acetaminophen hepatotoxicity , 2012, Drug metabolism reviews.

[17]  M. McNutt,et al.  Pathogenetic mechanisms of severe acute respiratory syndrome , 2007, Virus Research.

[18]  N. Shire,et al.  Liver injury and changes in hepatitis C Virus (HCV) RNA load associated with protease inhibitor-based antiretroviral therapy for treatment-naive HCV-HIV-coinfected patients: lopinavir-ritonavir versus nelfinavir. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  Yan Zhao,et al.  Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. , 2020, JAMA.

[20]  Z. Memish,et al.  Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study , 2013, The Lancet Infectious Diseases.

[21]  Bo Diao,et al.  Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19) , 2020, Frontiers in Immunology.

[22]  W. Liang,et al.  Clinical characteristics of 2019 novel coronavirus infection in China , 2020, medRxiv.

[23]  Hongzhou Lu,et al.  Efficacies of lopinavir/ritonavir and abidol in the treatment of novel coronavirus pneumonia , 2020 .

[24]  Yan Bai,et al.  Presumed Asymptomatic Carrier Transmission of COVID-19. , 2020, JAMA.

[25]  Ting Yu,et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study , 2020, The Lancet.