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

Le résumé fourni par la source

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.

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