Dig Dis. 2020 Aug 10. doi: 10.1159/000510758. Online ahead of print.
BACKGROUND: Abnormal liver function has been reported in patients with COVID-19 infection. Aim of our study was to report on the prevalence of liver injury in our cohort, to evaluate the association of mild vs severe liver injury with mortality in COVID-19 patients and to scrutinize the temporal pattern of viral detection and liver injury.
METHODS: We present data from a German cohort of 147 SARS-CoV-2 infected patients. The patients were divided into three groups according to their liver status during treatment. The first group included patients without elevated alanine aminotransferase or bilirubin, the third patients meeting the biochemical criteria of acute liver failure (ALF) and the second all other patients.
RESULTS: Liver injury was detected in 75 (50.7%) and 93 (63%) patients by admission and during treatment respectively. ALF was associated with the male sex, younger age and higher BMI. Mortality was associated with the presence of ALF (OR=9.423, 95%CI 2.410-36.858) in contrast to milder liver injury (OR 1.101, 95%CI 0.435-2.791). In 30% of patients with mild liver injury and in 50% of ALF patients, peak liver injury was observed at a time point, when the virus was no longer detectable in the respiratory tract.
CONCLUSION: Mild liver injury was not associated with worse outcome in our cohort and the pattern of liver injury did not fit well to the theory of SARS-CoV-2 directly causing liver impairment. Instead, severe liver injury in our cohort was associated multiple-organ failure and acute vascular events.