Liver injury in COVID-19: clinical features and risk factors

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OBJECTIVE

To identify risk factors and characteristics of liver damage in patients with COVID-19.

MATERIALS AND METHODS

We examined 200 medical records of COVID-19 patients who were admitted to the Central Clinical Hospital, Moscow from March 2020 to July 2021. Patients underwent general clinical, laboratory, and instrumental examinations.

RESULTS

A total of 166 patients (83%) had elevated liver enzymes, with 145 (86.8%) showing elevations below 5 ULN with the predominance of a cytolytic pattern. The use of paracetamol and amoxicillin with clavulanic acid was associated with an increased frequency of liver damage. The likelihood of liver damage in COVID-19 patients surged by 8.35-fold (95% CI: 2.49; 30.05, p=0.0006) with the use of five or more medications concurrently. Peak concentrations of AST and ALT were associated with COVID-19 severity and mortality. In three patients, autoimmune hepatitis was diagnosed 6—12 months after recovery from COVID-19.

CONCLUSION

The findings of this research highlight the complex origins of liver injury in COVID-19. Elevation of liver enzymes occurs more frequently than previously assumed and can persist even after recovery, being associated with a severe SARS-CoV-2 infection. Therefore, incorporating liver function tests into standard monitoring protocols during hospitalization and post-discharge is recommended.

Keywords:

COVID-19

Liver Diseases

elevated liver enzymes

autoimmune hepatitis

risk factors

Authors:

Zharova M.E.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-8325-5927

Ivanikov I.O.

Pirogov Russian National Research Medical University;
Central Clinical Hospital of Russian Federation Presidential Administration

ORCID: 0000-0001-6691-8306

Grigorieva Yu.V.

Pirogov Russian National Research Medical University;
Central Clinical Hospital of Russian Federation Presidential Administration

ORCID: 0000-0001-5335-7933

Nikonov E.L.

Pirogov Russian National Research Medical University

Scopus AuthorID: 57216680476
ResearcherID: T-9090-2017
ORCID: 0000-0003-3021-6534

Received:

22.05.2023

Accepted:

23.08.2023

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