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Zharova M.E.

Pirogov Russian National Research Medical University

Ivanikov I.O.

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

Grigorieva Yu.V.

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

Nikonov E.L.

Pirogov Russian National Research Medical University

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

Authors:

Zharova M.E., Ivanikov I.O., Grigorieva Yu.V., Nikonov E.L.

More about the authors

Journal: Russian Journal of Evidence-Based Gastroenterology. 2023;12(3): 51‑62

DOI: 10.17116/dokgastro20231203151

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Table of contents

LIVER INJURY IN COVID-19: CLINICAL FEATURES AND RISK FACTORS
LIVER INJURY IN COVID-19: CLINICAL FEATURES AND RISK FACTORS

To cite this article:

Zharova ME, Ivanikov IO, Grigorieva YuV, Nikonov EL. Liver injury in COVID-19: clinical features and risk factors. Russian Journal of Evidence-Based Gastroenterology. 2023;12(3):51‑62. (In Russ.)
https://doi.org/10.17116/dokgastro20231203151

Подписка 2026 Доказательная гастроэнтерология (Russian Journal of Evidence-Based Gastroenterology)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

Elevated liver enzymes are present in 9% to 24.7% of COVID-19 patients and correlate with disease severity. The pathogenesis and risk factors for liver damage in COVID-19 patients remain incompletely understood.

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

Ivanikov I.O.

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

Grigorieva Yu.V.

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

Nikonov E.L.

Pirogov Russian National Research Medical University

Received:

22.05.2023

Accepted:

23.08.2023

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