Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2022; 14(11): 1953-1963
Published online Nov 27, 2022. doi: 10.4254/wjh.v14.i11.1953
Liver test abnormalities in asymptomatic and mild COVID-19 patients and their association with viral shedding time
Si-Yi Yu, Jia-Rong Xie, Jun-Jun Luo, Hong-Peng Lu, Lei Xu, Jun-Jie Wang, Xue-Qin Chen
Si-Yi Yu, Jia-Rong Xie, Hong-Peng Lu, Lei Xu, Department of Gastroenterology, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
Jun-Jun Luo, Department of Cardiology, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
Jun-Jie Wang, Department of Information Technology, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
Xue-Qin Chen, Department of Traditional Medicine, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
Author contributions: Yu SY designed the study and drafted the manuscript; Yu SY, Luo JJ, Lu HP and Wang JJ organized the data; Yu SY and Xie JR performed the statistical analyses; Chen XQ and Xu L supervised the study design and conduction.
Supported by the Ningbo Medical Science and Technology Program, No. 2019Y32; Ningbo 2025 Science and Technology Major Project, No. 2021Z018; and Ningbo Natural Science Foundation of China, No. 2021J263.
Institutional review board statement: This study was approved by the Ethics Committee of Ningbo First Hospital (No. 2022RS069).
Informed consent statement: The data of our study was collected retrospectively, and the informed consent was exempted by the Ethics Committee of Ningbo First Hospital.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Qin Chen, Doctor, Professor, Department of Traditional Medicine, Ningbo First Hospital, No. 59 Liuting Street, Ningbo 315010, Zhejiang Province, China. cxq2316@163.com
Received: October 1, 2022
Peer-review started: October 1, 2022
First decision: October 17, 2022
Revised: October 25, 2022
Accepted: November 21, 2022
Article in press: November 21, 2022
Published online: November 27, 2022
Processing time: 53 Days and 23.5 Hours
Abstract
BACKGROUND

Asymptomatic infections and mild symptoms are common in patients infected with the Omicron variant, and data on liver test abnormalities are rare.

AIM

To evaluated the clinical characteristics of asymptomatic and mild coronavirus disease 2019 (COVID-19) patients with abnormal liver test results.

METHODS

This retrospective study included 661 laboratory-confirmed asymptomatic and mild COVID-19 patients who were treated in two makeshift hospitals in Ningbo from April 5, 2022 to April 29, 2022. Clinical information and viral shedding time were collected, and univariate and multivariate logistic regression models were performed in statistical analyses.

RESULTS

Of the 661 patients, 83 (12.6%) had liver test abnormalities, and 6 (0.9%) had liver injuries. Abnormal liver tests revealed a reliable correlation with a history of liver disease (P < 0.001) and a potential correlation with male sex and obesity (P < 0.05). Elevated alanine aminotransferase was reliably associated with obesity (P < 0.05) and a history of liver disease (P < 0.001). Elevated aspartate transaminase (AST) was reliably correlated with a history of liver disease (P < 0.001), and potentially correlated with age over 30 years (P < 0.05). There was a reliable correlation between AST ≥ 2× the upper limit of normal and a longer viral shedding time, especially in mild cases.

CONCLUSION

Obesity and a history of liver disease are risk factors for liver test abnormalities. Being male and an older age are potential risk factors. Attention should be given to liver tests in asymptomatic and mild COVID-19 patients, which has crucial clinical significance for evaluating the viral shedding time.

Keywords: COVID-19; Liver test abnormalities; Asymptomatic carriers; Mild cases; Viral shedding time; Risk factors

Core Tip: This is the first clinical study focusing on liver test abnormalities in asymptomatic and mild coronavirus disease 2019 patients. Unlike studies concerning severe cases, we focused on the association between liver test results and viral shedding time in patients infected with the Omicron BA2.2 variant, with a relatively high proportion of asymptomatic carriers and mild cases. The viral shedding time for patients with elevated aspartate transaminase were significantly longer, especially in mild patients. This provides crucial evidence for identifying high-risk patients with a prolonged viral shedding time.