COVID-19 Clinical Features

COVID-19 and Liver Impairment: How Often Are ALT and AST Elevated?

BACKGROUND AND PURPOSE:

Review of case studies and data
Setting
- The Fifth Medical Center of PLS General Hospital, Beijing, China
Data sources
- Authors analyzed 7 published studies plus their own unpublished data that included patients with COVID-19

Liver comorbidities: Patients with pre-existing liver conditions ranged from 2 to 11%
Abnormal levels of ALT and AST: Ranged from 14 to 53%
Patients with severe COVID-19 tend to have higher rates of liver dysfunction
- In one review, elevated AST was observed in
  - ICU patients: 62%
  - Non-ICU patients: 25%
- Fewer cases of abnormal AST levels were identified in the subclinical phase (before symptom onset) vs after symptom onset

There is some evidence that the liver is affected by COVID-19, but the extent and risk factors are still unknown
Liver damage in mild cases of COVID-19 is often transient and can return to normal with no special treatment | However, liver damage biomarkers are associated with poorer prognosis
The authors suggest that pre-existing liver and other conditions may also affect the liver damage caused by COVID-19, and should be further investigated
- Effect of glucocorticoids for patients with autoimmune hepatitis is uncertain
- Patients with primary biliary cholangitis may also be aggravated by COVID-19
- Patients with COVID-19 with liver cirrhosis or liver cancer might be more susceptible to SARS-CoV-2 infection

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