Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2020; 26(31): 4694-4702
Published online Aug 21, 2020. doi: 10.3748/wjg.v26.i31.4694
Clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan
Hu Zhang, Yu-Sheng Liao, Jing Gong, Jing Liu, Heng Zhang
Hu Zhang, Yu-Sheng Liao, Jing Gong, Jing Liu, Heng Zhang, Department of Gastroenterology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Author contributions: Zhang H designed this study and critically revised the manuscript; Zhang H, Gong J, and Liu J were responsible for data acquisition and extraction; Zhang H and Zhang H drafted the manuscript, analyzed the data, and interpreted the results; Gong J and Liao YS were involved in editing the manuscript; all authors read and approved the final manuscript to be published.
Supported by the Health and Family Planning Commission of Wuhan, No. WX18Y04.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Central Hospital of Wuhan.
Informed consent statement: The Ethics Committee of the Central Hospital of Wuhan waived the informed consent statement.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Heng Zhang, MA, MD, Chief Doctor, Department of Gastroenterology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Jiang’an District, Wuhan 430014, Hubei Province, China. 497697662@qq.com
Received: May 9, 2020
Peer-review started: May 9, 2020
First decision: June 13, 2020
Revised: June 20, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 21, 2020
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological, clinical, and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.

AIM

To investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.

METHODS

The 218 patients included 94 males (43.1%), aged 22 to 94 (50.1 ± 18.4) years. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were present in 42 (53.2%) and 36 (45.6%) cases, respectively, and 79 (36.2%) patients had abnormally elevated transaminase levels at admission. Patients with liver injury were older than those with normal liver function by a median of 12 years, with a significantly higher frequency of males (68.4% vs 28.8%, P < 0.001) and more coexisting illnesses (48.1% vs 27.3%, P = 0.002). Significantly more patients had fever and shortness of breath (87.3% vs 69.8% and 29.1% vs 14.4%, respectively) in the liver injury group. Only 12 (15.2%) patients had elevated total bilirubin. ALT and AST levels were mildly elevated [1-3 × upper limit of normal (ULN)] in 86.1% and 92.9% of cases, respectively. Only two (2.5%) patients had an ALT or AST level > 5 × ULN. Elevated γ-glutamyl transpeptidase was present in 45 (57.0%) patients, and 86.7% of these had a γ-glutamyl-transpeptidase level < 135 U/L (3 × ULN). Serum alkaline phosphatase levels were almost normal in all patients. Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients, but only one case had very high levels of aminotransferases.

RESULTS

Multivariate analysis revealed that male sex, high D-dimer level, and high neutrophil percentage were linked to a higher risk of liver injury. The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan. Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.

CONCLUSION

Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.

Keywords: COVID-19, Liver injury, Clinical characteristics, Risk factors

Core tip: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. This study analyzed the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan. The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels. Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.